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General NPI Number Information
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NPI Number | 1902425093
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Entity Type | Organization
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Legal Business Name | BLUE STAR REHABILITATION PLANO LLC
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 17754 PRESTON RD STE 100
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City | DALLAS
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State | TX
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Zip | 75252-5638
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Country | US
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Telephone | 972-476-9036
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Fax | 972-476-9926
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Provider Business Mailing Address
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Address Line | 800 W AIRPORT FWY # 959
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City | IRVING
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State | TX
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Zip | 75062-6312
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Country | US
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Telephone | 972-445-4134
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRIS PAUL GREEN
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Credential |
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Telephone | 972-445-4134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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