Provider Demographics
NPI:1093886459
Name:STAR REHABILITATION CORP
Entity Type:Organization
Organization Name:STAR REHABILITATION CORP
Other - Org Name:STAR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:951-600-7900
Mailing Address - Street 1:PO BOX 79396
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0179
Mailing Address - Country:US
Mailing Address - Phone:951-600-7900
Mailing Address - Fax:866-319-7682
Practice Address - Street 1:25389 MADISON AVE
Practice Address - Street 2:STE. 101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9006
Practice Address - Country:US
Practice Address - Phone:951-600-7900
Practice Address - Fax:951-600-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty