Provider Demographics
NPI:1952338022
Name:STARKS, MICHELLE LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:STARKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1311 S MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5464
Mailing Address - Country:US
Mailing Address - Phone:301-607-9096
Mailing Address - Fax:410-848-3909
Practice Address - Street 1:1311 S MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5464
Practice Address - Country:US
Practice Address - Phone:301-607-9096
Practice Address - Fax:410-848-3909
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD321566OtherMDIPA/OPTIMUM CHOICE
DCOH15DLOtherBC/BS
MD011164D87Medicare ID - Type Unspecified