Individual provider Active NPI

Kennedy Stewart, PT, DPT

  • Physical Therapist
  • Lawton, OK
National Provider Identifier
1104719145
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6594 Issued in OK
Practice address
3401 W Gore Blvd
Lawton, OK 73505-6332
Phone
(580) 355-8620
NPI assigned
May 29, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 6594 OK Primary

Addresses

Primary practice location

3401 W Gore Blvd
Lawton, OK 73505-6332

Mailing address

3409 Jacquelyn Ter
Duncan, OK 73533-1199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250626002735 OK Practitioner - Physical Therapist in Private Practice 2769994433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Powerback Rehabilitation LLCGroup PAC ID 2365359932, shared by 106 NPIs, 600 clinicians
Broad River RehabilitationGroup PAC ID 3375801350, 210 clinicians

Practice addresses (Care Compare)

501 SE Flower Mound Rd
Lawton, OK 73501-6388
Phone (580) 771-3266

6302 SW Lee Blvd
Lawton, OK 73505-9100
Phone (580) 536-6800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Broad River Rehabilitation Multi-Specialty CurrentSince Jun 16, 2025 Accepting new patients

Locations

1 Pond St
Arden, NC 28704
Phone 82877452220027

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1104719145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3409 JACQUELYN TER",
            "city": "DUNCAN",
            "state": "OK",
            "postal_code": "735331199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-355-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "KENNEDY",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-29",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "6594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.