MEDICARE: SARAH MELISSA STEWART PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA2551	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA2551	OTHER	AR	ARKANSAS LICENSE

General Provider Information

NPI Number	:	1235503046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MELISSA STEWART PTA

Provider Business Mailing Address
First Line	:	1530 E 11TH CV
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72802-2426
Country	:	US
Telephone Number	:	479-567-6677
Fax Number	:	479-495-3407

Provider Business Practice Location Address
First Line	:	408 N CHURCH ST
Second Line	:
City	:	ATKINS
State	:	AR
Zip	:	72823-0000
Country	:	US
Telephone Number	:	479-495-0651
Fax Number	:	479-495-3617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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