Provider Demographics
NPI:1518707504
Name:STAROST, KATHRYN ANN (PTA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:STAROST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:MASUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14818 PARKHURST DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-2211
Mailing Address - Country:US
Mailing Address - Phone:317-319-6846
Mailing Address - Fax:
Practice Address - Street 1:6338 W QUIET RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-0130
Practice Address - Country:US
Practice Address - Phone:317-707-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003019A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant