=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124397500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARK PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2011
-----------------------------------------------------
Last Update Date | 12/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 BELDEN VILLAGE ST NW LL03
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-701-4986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4150 BELDEN VILLAGE ST NW LL03
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-701-4986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. ALLISON LEE MARSDEN
-----------------------------------------------------
Credential | PT, DPT, OCS
-----------------------------------------------------
Telephone | 330-701-4986
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 007459
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------