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General NPI Number Information
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NPI Number | 1790876449
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Entity Type | Individual
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Provider Name | PAUL HUNTER STARK PT
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 375 N 9TH AVE STE B
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City | PENSACOLA
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State | FL
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Zip | 32502-4905
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Country | US
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Telephone | 850-912-9203
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Fax |
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Provider Business Mailing Address
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Address Line | 707 E CERVANTES ST STE B216
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City | PENSACOLA
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State | FL
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Zip | 32501-3286
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Country | US
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Telephone | 850-912-9203
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT293314
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 26714
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License Number State | FL
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