Healthcare Provider Details

I. General information

NPI: 1578690269
Provider Name (Legal Business Name): ANITA CLAIRE STEWART PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD
LOS ANGELES CA
90027
US

IV. Provider business mailing address

14335 HUSTON ST. 107
SHERMAN OAKS CA
91423-1820
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2118
  • Fax:
Mailing address:
  • Phone: 818-788-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: