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General NPI Number Information
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NPI Number | 1114382041
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Entity Type | Individual
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Provider Name | JUNKO STEWART PTA
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Gender | Female
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 2907 W BAY TO BAY BLVD SUITE 100
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City | TAMPA
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State | FL
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Zip | 33629-1706
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Country | US
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Telephone | 813-250-1208
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Fax | 813-250-1209
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Provider Business Mailing Address
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Address Line | 2907 W BAY TO BAY BLVD SUITE 100
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City | TAMPA
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State | FL
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Zip | 33629-1706
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Country | US
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Telephone | 813-250-1208
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Fax | 813-250-1209
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA25853
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License Number State | FL
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