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General NPI Number Information
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NPI Number | 1639304538
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Entity Type | Individual
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Provider Name | STEPHENIE M STARK MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 917 N 13TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18102-1124
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Country | US
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Telephone | 704-297-5648
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Fax |
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Provider Business Mailing Address
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Address Line | 917 N 13TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18102-1124
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Country | US
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Telephone | 704-297-5648
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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