Provider Demographics
NPI:1790043966
Name:STARKS, SHERRY IRENE (CMT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:IRENE
Last Name:STARKS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 SUNSET LN STE 204
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6129
Mailing Address - Country:US
Mailing Address - Phone:925-777-9000
Mailing Address - Fax:
Practice Address - Street 1:3731 SUNSET LN STE 204
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6129
Practice Address - Country:US
Practice Address - Phone:925-777-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist