Active NPI
Coleman R Stark
- Physical Therapist
- Orange Park, FL
National Provider Identifier
1659295772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 44932
- Practice address
- 794 Blanding Blvd
Orange Park, FL 32065-5721 - Phone
- (904) 203-1888
- Fax
- (904) 203-1888
- NPI assigned
- Aug 10, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 44932 | FL | Primary |
Addresses
Primary practice location
794 Blanding Blvd
Orange Park, FL 32065-5721
Mailing address
1370 Lakewood LN
Fleming Island, FL 32003-9013
Phone (904) 203-1888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786320000000",
"number": "1659295772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1370 LAKEWOOD LN",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320039013",
"telephone_number": "904-203-1888",
"fax_number": "904-203-1888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "794 BLANDING BLVD",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320655721",
"telephone_number": "904-203-1888",
"fax_number": "904-203-1888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "COLEMAN",
"middle_name": "R",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-08-10",
"last_updated": "2026-08-10",
"certification_date": "2026-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "FL",
"license": "44932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.