Healthcare Provider Details

I. General information

NPI: 1881912905
Provider Name (Legal Business Name): ELIZABETH SUZANN STEWART CPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SE 40TH ST
TOPEKA KS
66609-1427
US

IV. Provider business mailing address

141 SE 40TH ST
TOPEKA KS
66609-1427
US

V. Phone/Fax

Practice location:
  • Phone: 785-845-3790
  • Fax:
Mailing address:
  • Phone: 785-845-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number14-01907
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: