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General NPI Number Information
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NPI Number | 1306119102
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Entity Type | Individual
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Provider Name | ANTHONY JOHN STARK LPTA
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Gender | Male
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 3751 ROUND HILL RD APT 5
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City | SWANSEA
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State | IL
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Zip | 62226-1222
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Country | US
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Telephone | 469-939-6867
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Fax |
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Provider Business Mailing Address
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Address Line | 3751 ROUND HILL RD APT 5
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City | SWANSEA
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State | IL
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Zip | 62226-1222
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Country | US
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Telephone | 469-939-6867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 160.005649
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2067563
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2067563
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License Number State | TX
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