Individual
MR. RYAN STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1800 FLANDRO DR STE 190, POCATELLO, ID 83202-4940
(208) 233-2248
Mailing address
558 ALAMO ST, CHUBBUCK, ID 83202-7601
(208) 904-0165
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-3077
ID
Other
Enumeration date
03/18/2013
Last updated
03/18/2013
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