Provider Demographics
NPI:1952735227
Name:STEWART, WILLIAM B (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:STEWART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BRIARLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6784
Mailing Address - Country:US
Mailing Address - Phone:630-269-0913
Mailing Address - Fax:
Practice Address - Street 1:655 BRIARLEIGH WAY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6784
Practice Address - Country:US
Practice Address - Phone:630-269-0913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020086225100000X
GAPT015103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist