Active NPI
Olly Christian Stewart, PT, DPT
- Physical Therapist
- Waupun, WI
National Provider Identifier
1831825595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15851-24
- Practice address
- 620 W Brown St
Waupun, WI 53963-1702 - Phone
- (920) 324-5581
- NPI assigned
- Jul 26, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 15851-24 | WI | Primary |
Addresses
Primary practice location
620 W Brown St
Waupun, WI 53963-1702
Mailing address
405 Main St Apt 4
Lomira, WI 53048-9310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15851-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724371200000",
"number": "1831825595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 MAIN ST APT 4",
"city": "LOMIRA",
"state": "WI",
"postal_code": "530489310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 W BROWN ST",
"city": "WAUPUN",
"state": "WI",
"postal_code": "539631702",
"telephone_number": "920-324-5581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "OLLY",
"middle_name": "CHRISTIAN",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-26",
"last_updated": "2024-08-23",
"certification_date": "2024-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "15851-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waupun, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.