Provider Demographics
NPI:1952043762
Name:PS4B
Entity Type:Organization
Organization Name:PS4B
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:417-438-6624
Mailing Address - Street 1:3840 N BLACK CAT RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-7632
Mailing Address - Country:US
Mailing Address - Phone:417-438-6624
Mailing Address - Fax:
Practice Address - Street 1:301 E 4TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2262
Practice Address - Country:US
Practice Address - Phone:417-553-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PS4B
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-12
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty