Provider Demographics
NPI:1952777583
Name:STEWART, MARTIN ROBERT (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ROBERT
Last Name:STEWART
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-1331
Mailing Address - Country:US
Mailing Address - Phone:256-404-4759
Mailing Address - Fax:
Practice Address - Street 1:1035 W FORT WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2301
Practice Address - Country:US
Practice Address - Phone:256-249-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist