Basic Information
| Provider Information | |||||||||
| NPI: | 1104855782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | |||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 MATHEWS DR | ||||||||
| Address2: | STE D5 | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299263734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436815640 | ||||||||
| FaxNumber: | 8436815631 | ||||||||
| Practice Location | |||||||||
| Address1: | 38 SHERIDAN PARK CIR | ||||||||
| Address2: | STE E | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299107022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438155628 | ||||||||
| FaxNumber: | 8436815631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 630 | SC | Y | Other Service Providers | Specialist |
No ID Information.