Provider Demographics
NPI:1225461783
Name:STARR, VIRGINIA M (MPT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:STARR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:BIG HORN
Mailing Address - State:WY
Mailing Address - Zip Code:82833-0814
Mailing Address - Country:US
Mailing Address - Phone:307-429-0967
Mailing Address - Fax:
Practice Address - Street 1:228 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BIG HORN
Practice Address - State:WY
Practice Address - Zip Code:82833-5015
Practice Address - Country:US
Practice Address - Phone:307-578-1985
Practice Address - Fax:307-578-1938
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist