Healthcare Provider Details

I. General information

NPI: 1750318358
Provider Name (Legal Business Name): JAMES E. STARK ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N COLLEGE AVE
ANNVILLE PA
17003-1404
US

IV. Provider business mailing address

23 N GRANT ST
PALMYRA PA
17078-1816
US

V. Phone/Fax

Practice location:
  • Phone: 717-867-6269
  • Fax: 717-867-6881
Mailing address:
  • Phone: 717-838-7942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: