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General NPI Number Information
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NPI Number | 1093886459
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Entity Type | Organization
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Legal Business Name | STAR REHABILITATION CORP
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25389 MADISON AVE STE. 101
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City | MURRIETA
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State | CA
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Zip | 92562-9006
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Country | US
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Telephone | 951-600-7900
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Fax | 951-600-7908
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Provider Business Mailing Address
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Address Line | PO BOX 79396
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City | CORONA
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State | CA
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Zip | 92877-0179
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Country | US
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Telephone | 951-600-7900
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Fax | 866-319-7682
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES LEE KO
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Credential | P.T.
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Telephone | 951-600-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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