Provider Demographics
NPI:1366960684
Name:STARKE, JONATHON (DPT)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:STARKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 N BROADMOOR ST UNIT 466
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2699
Mailing Address - Country:US
Mailing Address - Phone:660-281-4420
Mailing Address - Fax:
Practice Address - Street 1:1855 S ROCK RD STE 155
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5113
Practice Address - Country:US
Practice Address - Phone:316-682-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017027012225100000X
KS11-07798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-07798OtherKANSAS STATE BOARD OF HEALING ARTS
MO2017027012OtherMISSOURI BOARD OF HEALING ARTS