Healthcare Provider Details

I. General information

NPI: 1568670487
Provider Name (Legal Business Name): DAVID HERRINGTON STEWART PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WEST DYKES STREET
COCHRAN GA
31014
US

IV. Provider business mailing address

711 HUNTINGTON CHASE CT
WARNER ROBINS GA
31088-2690
US

V. Phone/Fax

Practice location:
  • Phone: 478-394-7704
  • Fax: 229-868-2175
Mailing address:
  • Phone: 706-564-1974
  • Fax: 229-868-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8444
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: