Provider Demographics
NPI:1598778995
Name:STAR, PATTI A (LMT)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:A
Last Name:STAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2716
Mailing Address - Country:US
Mailing Address - Phone:941-356-7768
Mailing Address - Fax:941-363-9883
Practice Address - Street 1:1320 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2716
Practice Address - Country:US
Practice Address - Phone:941-356-7768
Practice Address - Fax:941-363-9883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28053225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist