Provider Demographics
NPI:1831528462
Name:STEWART, ELLEN SUE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SUE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N BRADLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1539
Mailing Address - Country:US
Mailing Address - Phone:989-734-7545
Mailing Address - Fax:989-734-7648
Practice Address - Street 1:555 N BRADLEY HWY
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1539
Practice Address - Country:US
Practice Address - Phone:989-734-7545
Practice Address - Fax:989-734-7648
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3157781225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant