Provider Demographics
NPI:1568060267
Name:STARK, CAROLINE (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 GRANITE ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5350
Mailing Address - Country:US
Mailing Address - Phone:978-877-8370
Mailing Address - Fax:
Practice Address - Street 1:67 PARKHURST RD UNIT 3
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1518
Practice Address - Country:US
Practice Address - Phone:978-935-4055
Practice Address - Fax:978-455-2165
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist