Healthcare Provider Details

I. General information

NPI: 1083915722
Provider Name (Legal Business Name): JULIA MARIE STEWART LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 S EDMUNDS ST
SEATTLE WA
98118
US

IV. Provider business mailing address

2420 S IRVING ST
SEATTLE WA
98144-3728
US

V. Phone/Fax

Practice location:
  • Phone: 206-380-4785
  • Fax:
Mailing address:
  • Phone: 206-380-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA60166314
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: