Healthcare Provider Details

I. General information

NPI: 1992133557
Provider Name (Legal Business Name): STAR PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CENTRAL AVE
CHELSEA MA
02150-3203
US

IV. Provider business mailing address

32 CENTRAL AVE
CHELSEA MA
02150-3203
US

V. Phone/Fax

Practice location:
  • Phone: 617-889-3390
  • Fax:
Mailing address:
  • Phone: 617-889-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: GEORGE LAKA
Title or Position: PRESIDENT
Credential:
Phone: 617-889-3390