Provider Demographics
NPI:1568177947
Name:STARK REHABILITATION, LLC
Entity Type:Organization
Organization Name:STARK REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:407-484-8368
Mailing Address - Street 1:6052 TURKEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4219
Mailing Address - Country:US
Mailing Address - Phone:407-305-2511
Mailing Address - Fax:
Practice Address - Street 1:6052 TURKEY LAKE RD STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4219
Practice Address - Country:US
Practice Address - Phone:407-484-8368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty