Provider Demographics
NPI:1124397500
Name:STARK PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:STARK PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:330-701-4986
Mailing Address - Street 1:4150 BELDEN VILLAGE ST NW
Mailing Address - Street 2:LL03
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2595
Mailing Address - Country:US
Mailing Address - Phone:330-701-4986
Mailing Address - Fax:
Practice Address - Street 1:4150 BELDEN VILLAGE ST NW
Practice Address - Street 2:LL03
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2595
Practice Address - Country:US
Practice Address - Phone:330-701-4986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0074592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty