Individual
JIM STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9653-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40445700
—
WI
01
—
P00452811
RR MEDICARE
WI
Enumeration date
07/28/2005
Last updated
12/29/2010
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