Provider Demographics
NPI:1730063751
Name:STARK, TESHA L (LMT-MT-20187)
Entity type:Individual
Prefix:
First Name:TESHA
Middle Name:L
Last Name:STARK
Suffix:
Gender:F
Credentials:LMT-MT-20187
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 1689
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-1689
Mailing Address - Country:US
Mailing Address - Phone:406-210-4309
Mailing Address - Fax:
Practice Address - Street 1:7671 MT HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-9423
Practice Address - Country:US
Practice Address - Phone:406-210-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-MT-20187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist