Amy Rae Stark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QS00305100 Issued in NJ

Practice address

3 Stephenville Pkwy Ste 2C
Edison, NJ 08820-3061

Phone

(908) 293-8636

NPI assigned

Jul 11, 2021

Sex

Female

Sole proprietor

Yes

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)

Enrolled

State licenses

Practice roles

Locations

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

• Divine Spine Physical Therapy and Yoga LLC

  • Physical Therapy Clinic/Center
  • Monroe, NJ
  • NPI 1043756778

  Physical Therapist

  NPD

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

{
    "created_epoch": "1625961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625961600000",
    "number": "1831761840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 GOODALE CIR",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011607",
            "telephone_number": "908-202-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 STEPHENVILLE PKWY STE 2C",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203061",
            "telephone_number": "908-293-8636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "AMY",
        "middle_name": "RAE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-11",
        "last_updated": "2021-07-11",
        "certification_date": "2021-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QS00305100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spring Hills Therapy, LLC
• Aruna Sree, M.D.
• Kousik Surya Sridharan, MD
• Stanford Angels LLC
• Luke Stanton
• State of New Jersey Omb Centralized Payroll
• Makila Statum
• Seth I Stein, MD
• Gary Bruce Steinbach, MD
• Elyse A Steinberg, LSW

• All providers in Edison, NJ
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2021; 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.