Individual
JEDADIAH L STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
419 NE 4TH AVE, CAMAS, WA 98607-2129
(360) 210-5266
Mailing address
419 NE 4TH AVE, CAMAS, WA 98607-2129
(360) 210-5266
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA60022696
WA
Other
Enumeration date
12/15/2010
Last updated
12/15/2010
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