Healthcare Provider Details

I. General information

NPI: 1144461740
Provider Name (Legal Business Name): ERIN SAMANTHA STEWARD P.T., D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S ERIE AVE
RUSSELLVILLE AR
72801-6857
US

IV. Provider business mailing address

1101 S ERIE AVE
RUSSELLVILLE AR
72801-6857
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-1198
  • Fax: 479-967-1178
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3130
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021034054
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: