MEDICARE: SAMANTHA A STEWART DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	25606	MD
2	225100000X	Physical Therapist	PT5140	HI

General Provider Information

NPI Number	:	1427424886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA A STEWART DPT

Provider Business Mailing Address
First Line	:	95-199 HOAHELE PLACE
Second Line	:
City	:	MILILANI
State	:	HI
Zip	:	96789-5544
Country	:	US
Telephone Number	:	808-674-0500
Fax Number	:	808-674-0511

Provider Business Practice Location Address
First Line	:	99-128 AIEA HEIGHTS DRIVE
Second Line	:	STE 207
City	:	AIEA
State	:	HI
Zip	:	96701-3968
Country	:	US
Telephone Number	:	808-487-0487
Fax Number	:	808-486-8674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	09/20/2021

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