Theresa Rose Stark, LMT, BCTMB

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227-008050 Issued in IL

Practice address

3850 W 95TH Street
Evergreen Park, IL 60805-2034

Phone

(773) 556-5333

Fax

(708) 843-5811

NPI assigned

Mar 12, 2009

Last updated

Sep 21, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Functionally Balanced Bodywork Clinics, LLC

  • Clinic/Center
  • Evergreen Park, IL
  • NPI 1497210850
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537488000000",
    "number": "1275774788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 W 95TH STREET",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052034",
            "telephone_number": "773-556-5333",
            "fax_number": "708-843-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 W 95TH STREET",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052034",
            "telephone_number": "773-556-5333",
            "fax_number": "708-843-5811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "THERESA",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "LMT, BCTMB",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-12",
        "last_updated": "2018-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227-008050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joaquim Spadoni Barboza, M.D.
• William H Spear, M.D.
• Lara Stachler
• Michael M Stachowski, M.D.
• Stanley a Polit MD, SC
• Laura Stecich
• Stellar Health Experts, PLLC
• Stellar Health Experts, PLLC
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• Tricia Katherine Stimac, D.V.M.

• Massage Therapist in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.