Ric Douglas Stark, P.T.
Individual provider Active NPI Physical Therapist · Hana, HI
NPI 1124357744 · NPPES record last updated Dec 10, 2009
Key facts
- NPI
- 1124357744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT 722 (HI)
- Practice address
- 4351 Hana Highway
Hana, HI 96713 - Phone
- (808) 895-9350
- NPI assigned
- Dec 10, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 722 | HI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 722 | HI | Yes |
Addresses
Primary practice location
4351 Hana Highway
Hana, HI 96713
Mailing address
PO Box 970
Hana, HI 96713-0970
Phone (808) 895-9350
Other providers in Hana, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.