Provider Demographics
NPI:1588117311
Name:STARSICK, DUSTIN RYAN (DPT)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:RYAN
Last Name:STARSICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2049
Mailing Address - Country:US
Mailing Address - Phone:304-845-8101
Mailing Address - Fax:304-345-7386
Practice Address - Street 1:1015 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2049
Practice Address - Country:US
Practice Address - Phone:304-845-8101
Practice Address - Fax:304-345-7386
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist