Provider Demographics
NPI:1366747594
Name:STEWART, WILL G (RRT)
Entity type:Individual
Prefix:MR
First Name:WILL
Middle Name:G
Last Name:STEWART
Suffix:
Gender:M
Credentials:RRT
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Mailing Address - Street 1:2001 S WOODRUFF AVE
Mailing Address - Street 2:SUITE 12B
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6374
Mailing Address - Country:US
Mailing Address - Phone:208-529-2498
Mailing Address - Fax:208-528-7971
Practice Address - Street 1:2001 S WOODRUFF AVE
Practice Address - Street 2:SUITE 12B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6374
Practice Address - Country:US
Practice Address - Phone:208-529-2498
Practice Address - Fax:208-528-7971
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDLRT1572279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist