Provider Demographics
NPI:1093084469
Name:STAR SPINE THERAPY & AMPUTEE REHABILITATION, PLLC
Entity Type:Organization
Organization Name:STAR SPINE THERAPY & AMPUTEE REHABILITATION, PLLC
Other - Org Name:BELLAIRE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:ISSAC
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:832-588-3552
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0141
Mailing Address - Country:US
Mailing Address - Phone:832-588-3552
Mailing Address - Fax:281-402-3077
Practice Address - Street 1:6708 FERRIS ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3919
Practice Address - Country:US
Practice Address - Phone:832-588-3552
Practice Address - Fax:281-402-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1192943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353722701Medicaid