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General NPI Number Information
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NPI Number | 1932383965
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Entity Type | Organization
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Legal Business Name | FIVE STAR PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 936 WEST ANDREWS AVENUE
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City | HENDERSON
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State | NC
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Zip | 27536
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Country | US
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Telephone | 252-436-6510
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Fax | 252-438-2163
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Provider Business Mailing Address
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Address Line | PO BOX 1696
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City | HENDERSON
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State | NC
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Zip | 27536-1696
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Country | US
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Telephone | 252-436-6510
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Fax | 252-438-2163
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Authorized Official
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Title or Position | PRESIDENT, DIRECTOR
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Name | MRS. REBEKAH A MARTIN
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Credential | P.T.
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Telephone | 252-436-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 10604
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License Number State | NC
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