Provider Demographics
NPI:1891319927
Name:STARK PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STARK PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:601-540-1086
Mailing Address - Street 1:707 E CERVANTES STREET, SUITE B #216
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501
Mailing Address - Country:US
Mailing Address - Phone:601-540-1086
Mailing Address - Fax:
Practice Address - Street 1:375 N 9TH AVE STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4905
Practice Address - Country:US
Practice Address - Phone:601-540-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy