MEDICARE: FIVE STAR REHABILITATION AND WELLNESS SERVICES, 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		AZ

General Provider Information

NPI Number	:	1265943146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC

Provider Business Mailing Address
First Line	:	255 WASHINGTON ST STE 230
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458-1644
Country	:	US
Telephone Number	:	617-796-8387
Fax Number	:

Provider Business Practice Location Address
First Line	:	8151 E SPEEDWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-3323
Country	:	US
Telephone Number	:	617-796-8174
Fax Number	:	617-762-1976

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	JEFFREY C LEER
Credential	:
Telephone Number	:	617-796-8387

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	10/18/2022

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