Healthcare Provider Details

I. General information

NPI: 1891341897
Provider Name (Legal Business Name): KATHERINE STARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 JOHN ST
FAIRHAVEN MA
02719-1925
US

IV. Provider business mailing address

576 BROADHOLLOW RD STE PROEX
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 774-644-9081
  • Fax:
Mailing address:
  • Phone: 631-359-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: