Provider Demographics
NPI:1649782822
Name:STEWART PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:STEWART PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:662-710-2844
Mailing Address - Street 1:896 RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-0804
Mailing Address - Country:US
Mailing Address - Phone:901-233-6815
Mailing Address - Fax:
Practice Address - Street 1:2136 EXETER RD STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3935
Practice Address - Country:US
Practice Address - Phone:901-480-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty