MEDICARE: JUSTIN RANDALL STEWART PT

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	225100000X	Physical Therapist	9849	GA

General Provider Information

NPI Number	:	1265762496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN RANDALL STEWART PT

Provider Business Mailing Address
First Line	:	1251 FOUNDERS LAKE DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-7645
Country	:	US
Telephone Number	:	706-614-5772
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 CARTER RD
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30518-1628
Country	:	US
Telephone Number	:	706-614-5772
Fax Number	:	770-614-5991

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

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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Directions to “ JUSTIN RANDALL STEWART PT” Practice Location

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