Provider Demographics
NPI:1073157517
Name:TOLBERT, STARR BRITTNI (PTA)
Entity Type:Individual
Prefix:
First Name:STARR
Middle Name:BRITTNI
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W HEATHERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2790
Mailing Address - Country:US
Mailing Address - Phone:864-506-6789
Mailing Address - Fax:
Practice Address - Street 1:2709 PELHAM RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4083
Practice Address - Country:US
Practice Address - Phone:864-242-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4158225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant