Provider Demographics
NPI:1639304538
Name:STARK, STEPHENIE M (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:M
Last Name:STARK
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-1124
Mailing Address - Country:US
Mailing Address - Phone:704-297-5648
Mailing Address - Fax:
Practice Address - Street 1:917 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-1124
Practice Address - Country:US
Practice Address - Phone:704-297-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer