MEDICARE: MARYJEAN STARR DPT

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

General Provider Information

NPI Number	:	1528415031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYJEAN STARR DPT

Provider Business Mailing Address
First Line	:	383 CORBIN CENTER DRIVE
Second Line	:	PT PROS, INC.
City	:	CORBIN
State	:	KY
Zip	:	40701-1895
Country	:	US
Telephone Number	:	606-526-2909
Fax Number	:	606-526-2901

Provider Business Practice Location Address
First Line	:	1713 NICHOLASVILLE RD.
Second Line	:	PT PROS, INC.
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1403
Country	:	US
Telephone Number	:	859-402-1220
Fax Number	:	859-402-1245

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	03/03/2021

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