Healthcare Provider Details

I. General information

NPI: 1801973995
Provider Name (Legal Business Name): RICK D. STEWART P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 MAIN ST. N E SUITE 101
DUVALL WA
98019
US

IV. Provider business mailing address

PO BOX 161
DUVALL WA
98019-0161
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-0505
  • Fax: 425-788-3340
Mailing address:
  • Phone: 425-788-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00002825
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: