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General NPI Number Information
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NPI Number | 1952043762
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Entity Type | Organization
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Legal Business Name | PS4B
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 301 E 4TH ST
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City | JOPLIN
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State | MO
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Zip | 64801-2262
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Country | US
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Telephone | 417-553-0520
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Fax |
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Provider Business Mailing Address
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Address Line | 3840 N BLACK CAT RD
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City | JOPLIN
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State | MO
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Zip | 64801-7632
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Country | US
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Telephone | 417-438-6624
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Fax |
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Authorized Official
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Title or Position | OWNER/LMT
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Name | SARAH STARKS
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Credential | LMT
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Telephone | 417-438-6624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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