| 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 |