Basic Information
| Provider Information | |||||||||
| NPI: | 1972657807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | TORTORICH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 CAMBROOKE | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394027829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014669938 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6134 HWY 98 WEST | ||||||||
| Address2: | SUITE 21 | ||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394026020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013367155 | ||||||||
| FaxNumber: | 6013367782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 05/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT04355 | LA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT3116 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.