Provider Demographics
NPI:1588936827
Name:STARKS, EMILY ELIZABETH (PTA)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:STARKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 MEL MARGO AVE NE APT 1204
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4850
Mailing Address - Country:US
Mailing Address - Phone:386-688-1095
Mailing Address - Fax:
Practice Address - Street 1:207 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-1835
Practice Address - Country:US
Practice Address - Phone:850-584-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22620225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant