Healthcare Provider Details

I. General information

NPI: 1235503046
Provider Name (Legal Business Name): SARAH MELISSA STEWART PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N CHURCH ST
ATKINS AR
72823-0000
US

IV. Provider business mailing address

1530 E 11TH CV
RUSSELLVILLE AR
72802-2426
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-0651
  • Fax: 479-495-3617
Mailing address:
  • Phone: 479-567-6677
  • Fax: 479-495-3407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2551
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: