Healthcare Provider Details

I. General information

NPI: 1326529264
Provider Name (Legal Business Name): KIMBERLY MARIE STARK LMT, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 N GRANT ST STE 100
DENVER CO
80203-2907
US

IV. Provider business mailing address

2682 S CATHAY WAY UNIT 111
AURORA CO
80013-6047
US

V. Phone/Fax

Practice location:
  • Phone: 303-832-3668
  • Fax:
Mailing address:
  • Phone: 610-203-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0020153
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: