Basic Information
| Provider Information | |||||||||
| NPI: | 1568670487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | HERRINGTON | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 HUNTINGTON CHASE CT | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310882690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065641974 | ||||||||
| FaxNumber: | 2298682175 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 WEST DYKES STREET | ||||||||
| Address2: | |||||||||
| City: | COCHRAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783947704 | ||||||||
| FaxNumber: | 2298682175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| 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 | 225100000X | 8444 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.