MEDICARE: STARR SPINE PHYSICAL THERAPY AND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1083179592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARR SPINE PHYSICAL THERAPY AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	3338 COLUMBUS ST
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2624
Country	:	US
Telephone Number	:	614-594-2400
Fax Number	:	614-594-2401

Provider Business Practice Location Address
First Line	:	3338 COLUMBUS ST
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2624
Country	:	US
Telephone Number	:	614-594-2400
Fax Number	:	614-594-2401

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES LAMONT STARR
Credential	:	DPT
Telephone Number	:	614-214-5647

Provider Enumeration Date	:	02/08/2019
Last Update Date	:	03/20/2023

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