Healthcare Provider Details

I. General information

NPI: 1053968222
Provider Name (Legal Business Name): STEWART PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 MOCKINGBIRD LANE SUITE A
PARAGOULD AR
72450
US

IV. Provider business mailing address

151 GREENE 789 RD
PARAGOULD AR
72450-5990
US

V. Phone/Fax

Practice location:
  • Phone: 870-476-9017
  • Fax: 870-362-2018
Mailing address:
  • Phone: 870-476-9017
  • Fax: 870-362-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE JILL STEWART
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: MSPT
Phone: 870-476-9017