Healthcare Provider Details

I. General information

NPI: 1518909365
Provider Name (Legal Business Name): SUZANNE BAKER STEWART P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 AVENUE C SUITE 3
KUNA ID
83634-2004
US

IV. Provider business mailing address

PO BOX 215
KUNA ID
83634-0215
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-5057
  • Fax:
Mailing address:
  • Phone: 208-922-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberRPT-1844
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: