Provider Demographics
NPI:1396866166
Name:STARKS, RHONDA CAROL (LMP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:CAROL
Last Name:STARKS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 114TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-2720
Mailing Address - Country:US
Mailing Address - Phone:253-229-1108
Mailing Address - Fax:
Practice Address - Street 1:1011 E MAIN
Practice Address - Street 2:A201
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6779
Practice Address - Country:US
Practice Address - Phone:253-845-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist