Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | J1-0003014 | DE |
N | 2251S0007X | Physical Therapist - Sports | J1-0003014 | DE |
NPI | 1427499516 |
---|---|
Provider Name | Heather Stewart |
First Address | Middletown, DE 19709-1630 |
Second Address | Middletown, DE 19709-1630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2013 |
Last Update Date | 17/07/2013 |