Provider Demographics
NPI:1174231583
Name:STEWART, PAMELA ANN (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:STEWART-CREGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17 NORMANDY AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1664
Mailing Address - Country:US
Mailing Address - Phone:508-340-5549
Mailing Address - Fax:
Practice Address - Street 1:10 MARY SCANO DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2884
Practice Address - Country:US
Practice Address - Phone:508-754-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134454225100000X
MA9831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist