NPI | 1750460341 |
---|---|
Other Name | TERESSA GAIL STARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL po2420) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: FL po2420) |
213E00000X Podiatrist (Licence: AL 160) | |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AL 160) | |
213ER0200X Podiatrist, Radiology (Licence: FL po2420) | |
213ER0200X Podiatrist, Radiology (Licence: AL 160) | |
213ES0000X Podiatrist, Sports Medicine (Licence: FL po2420) | |
213ES0000X Podiatrist, Sports Medicine (Licence: AL 160) | |
213ES0131X Podiatrist, Foot Surgery (Licence: FL po2420) | |
213ES0131X Podiatrist, Foot Surgery (Licence: AL 160) | |
Enumeration Date | 2006-11-03 |
Last Update Date | 2012-05-10 |