=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750890018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAITLIN STEWART
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2017
-----------------------------------------------------
Last Update Date | 09/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14012 ROUTE 31
-----------------------------------------------------
City | ALBION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14411-9301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-589-3239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 292 RIDGEWOOD DR
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14226-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 042219
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------