Healthcare Provider Details

I. General information

NPI: 1528294295
Provider Name (Legal Business Name): MATT STEWART PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CROWN POINTE BLVD
WILLOW PARK TX
76087-1191
US

IV. Provider business mailing address

14841 BELCLAIRE AVE
ALEDO TX
76008-1577
US

V. Phone/Fax

Practice location:
  • Phone: 817-757-1580
  • Fax:
Mailing address:
  • Phone: 817-781-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1189368
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: