1588608236 NPI number — LINDA D STEWART PT

Table of content: LINDA D STEWART PT (NPI 1588608236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588608236 NPI number — LINDA D STEWART PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
LINDA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588608236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1083 PRAIRIE ZINNIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERNALILLO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87004-5801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-901-0743
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1083 PRAIRIE ZINNIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERNALILLO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87004-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-933-7994
Provider Business Practice Location Address Fax Number:
505-930-7136
Provider Enumeration Date:
06/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT4211 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51502735 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51531831 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".