Basic Information
| Provider Information | |||||||||
| NPI: | 1669668760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PT, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7858 SHRADER RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232944222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042701305 | ||||||||
| FaxNumber: | 8042739294 | ||||||||
| Practice Location | |||||||||
| Address1: | 7858 SHRADER RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232944222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042701305 | ||||||||
| FaxNumber: | 8042739294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2007 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305001047 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1669668760 | 05 | VA | MEDICAID | 7717894 | 01 | VA | AETNA | OTHER | 192944 | 01 | VA | BCBS (PHYSICAL THERAPY) | OTHER | P00467139 | 01 | VA | MEDICARE RAILROAD | OTHER |