Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1153775 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 1153775 | TX |
NPI | 1083828289 |
---|---|
Provider Name | Mrs. Staci Nicole Stewart |
First Address | Rosenberg, TX 77471-5759 |
Second Address | Missouri City, TX 77459-4062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 09/07/2007 |