Provider Demographics
NPI:1730148875
Name:STEWART, RODNEY DOUGLAS (RPT)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:DOUGLAS
Last Name:STEWART
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HWY 99 N STE 1
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9152
Mailing Address - Country:US
Mailing Address - Phone:541-482-9051
Mailing Address - Fax:
Practice Address - Street 1:1801 HWY 99 N STE 1
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9152
Practice Address - Country:US
Practice Address - Phone:541-482-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV-1312225100000X
OROR-4795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003404007Medicaid
NVV38224Medicare PIN
ORR120603Medicare PIN
NV1730148875Medicare PIN
NV003404007Medicaid
OR4569680003Medicare NSC