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Individual
SHANE STARK
Active
Individual
SHANE STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL MASSAGE LMT
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19432
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19432
19432
OR
Enumeration date
11/26/2021
Last updated
11/26/2021
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