Healthcare Provider Details

I. General information

NPI: 1508661018
Provider Name (Legal Business Name): STEWART WILENT DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16621 CHAMPION WAY STE 100
SANDY OR
97055-7258
US

IV. Provider business mailing address

10121 SE SUNNYSIDE RD STE 208
CLACKAMAS OR
97015-5750
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5321
  • Fax: 503-668-9742
Mailing address:
  • Phone: 503-668-5321
  • Fax: 503-668-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65601
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: