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NPI Code Detail

MEDICARE: FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC.

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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1861953929
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 : 617-796-8350
Fax Number :
Provider Business Practice Location Address
First Line : 4590 KNIGHTSBRIDGE BLVD
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-4327
Country : US
Telephone Number : 314-451-6793
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CHIEF EXECUTIVE OFFICER
Name : JEFFREY C LEER
Credential :
Telephone Number : 617-796-8387
Provider Enumeration Date : 03/29/2019
Last Update Date : 10/20/2022

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