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

General Provider Information

NPI Number	:	1578576906
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	:	3004 NORTH RIDGE ROAD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3381
Country	:	US
Telephone Number	:	410-480-2175
Fax Number	:	410-750-1240

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/18/2022

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