Provider Demographics
NPI:1114169067
Name:STARK, AMBER LYNN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:STARK
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9063 W FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4682
Mailing Address - Country:US
Mailing Address - Phone:732-757-2582
Mailing Address - Fax:
Practice Address - Street 1:8357 N RAMPART RANGE RD STE 205
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-9365
Practice Address - Country:US
Practice Address - Phone:303-932-0081
Practice Address - Fax:303-932-1363
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO507225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist