Healthcare Provider Details

I. General information

NPI: 1497176101
Provider Name (Legal Business Name): JACQUELINE ANN DE WITT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE ANN STEWART

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 UNION ST
SCHENECTADY NY
12308-3023
US

IV. Provider business mailing address

1046 BELRIDGE RD
NISKAYUNA NY
12309-4718
US

V. Phone/Fax

Practice location:
  • Phone: 518-346-0605
  • Fax: 518-346-0726
Mailing address:
  • Phone: 518-258-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21432
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0071130
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number032924-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number032924-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number032924-1
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032924-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: