Basic Information
| Provider Information | |||||||||
| NPI: | 1932383965 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIVE STAR PHYSICAL THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1696 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275361696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524366510 | ||||||||
| FaxNumber: | 2524382163 | ||||||||
| Practice Location | |||||||||
| Address1: | 936 WEST ANDREWS AVENUE | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524366510 | ||||||||
| FaxNumber: | 2524382163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | REBEKAH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2524366510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 10604 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.