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NPI Code Detail

MEDICARE: BLUE STAR REHABILITATION PLANO LLC

MEDICARE: BLUE STAR REHABILITATION PLANO 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11588051114OTHERTXADDITIONAL ORGANIZATION NPI

General Provider Information

NPI Number : 1902425093
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE STAR REHABILITATION PLANO LLC
Provider Business Mailing Address
First Line : 800 W AIRPORT FWY # 959
Second Line :
City : IRVING
State : TX
Zip : 75062-6312
Country : US
Telephone Number : 972-445-4134
Fax Number :
Provider Business Practice Location Address
First Line : 17754 PRESTON RD STE 100
Second Line :
City : DALLAS
State : TX
Zip : 75252-5638
Country : US
Telephone Number : 972-476-9036
Fax Number : 972-476-9926
Authorized Official
Title or Position : OWNER
Name : MR. CHRIS PAUL GREEN
Credential :
Telephone Number : 972-445-4134
Provider Enumeration Date : 04/09/2020
Last Update Date : 10/02/2023

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Directions to “BLUE STAR REHABILITATION PLANO LLC ” Practice Location

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