MEDICARE: KATHRYN STARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9192	SC

General Provider Information

NPI Number	:	1043704109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN STARK

Provider Business Mailing Address
First Line	:	1239 OXBOW DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 WAPPOO CREEK DR STE 7
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2143
Country	:	US
Telephone Number	:	843-430-6347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	02/16/2026

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Directions to “ KATHRYN STARK ” Practice Location

Language	Start Address	Practice Location

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