Provider Demographics
NPI:1447294418
Name:STARKEY, MARTY (PT)
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:
Last Name:STARKEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10791
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0791
Mailing Address - Country:US
Mailing Address - Phone:479-651-1148
Mailing Address - Fax:479-632-0323
Practice Address - Street 1:1414 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-4723
Practice Address - Country:US
Practice Address - Phone:479-632-0321
Practice Address - Fax:479-632-0323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56530OtherAR BLUE CROSS/SHIELD
AR56530OtherAR BLUE CROSS/SHIELD