Healthcare Provider Details

I. General information

NPI: 1093103285
Provider Name (Legal Business Name): FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 N VALLEY FORGE RD
DEVON PA
19333-1239
US

IV. Provider business mailing address

255 WASHINGTON ST STE 230
NEWTON MA
02458-1644
US

V. Phone/Fax

Practice location:
  • Phone: 610-263-2300
  • Fax: 610-688-1391
Mailing address:
  • Phone: 617-796-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY C LEER
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-796-8387