Individual
STACEY STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
82 NEW PARK AVE, NORTH FRANKLIN, CT 06254-1807
(860) 823-6221
Mailing address
148 WOODBINE RD, COLCHESTER, CT 06415-1884
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT21572
LICENSE #
FL
Enumeration date
08/30/2006
Last updated
11/26/2012
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