NPI | 1003890229 |
---|---|
Former Name | CHRISTINE MARIE STARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT17235) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 17235) |
2251H1200X Physical Therapist, Hand (Licence: CA PT17235) | |
Enumeration Date | 2005-12-01 |
Last Update Date | 2019-11-07 |