MEDICARE: CATHERINE MILLER STEWART PT, DPT, NCS

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	2251N0400X	Neurology Physical Therapist	1209360	TX

General Provider Information

NPI Number	:	1811423577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MILLER STEWART PT, DPT, NCS

Provider Business Mailing Address
First Line	:	2608 MUSEUM WAY
Second Line	:	NO. 3206
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3080
Country	:	US
Telephone Number	:	704-619-0905
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 CAMP BOWIE BLVD
Second Line	:	SUITE 141
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7163
Country	:	US
Telephone Number	:	682-312-7693
Fax Number	:

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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