Provider Demographics
NPI:1700977345
Name:STARKS, LAURA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:R
Last Name:STARKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 TRIPLE CROWN COURT
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637
Mailing Address - Country:US
Mailing Address - Phone:301-274-0305
Mailing Address - Fax:301-290-1313
Practice Address - Street 1:29770 THREE NOTCH ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622
Practice Address - Country:US
Practice Address - Phone:301-290-0800
Practice Address - Fax:301-290-1313
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2139917OtherUNITED HC MAMSI
MDT1620005OtherBCBS
MD60999601OtherCAREFIRST
MD2139917OtherUNITED HC MAMSI