Provider Demographics
NPI:1467054148
Name:5 STAR THERAPY LLC
Entity Type:Organization
Organization Name:5 STAR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-725-4555
Mailing Address - Street 1:5702 MCPHERSON RD STE 15
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6884
Mailing Address - Country:US
Mailing Address - Phone:956-725-4555
Mailing Address - Fax:956-725-3555
Practice Address - Street 1:5702 MCPHERSON RD STE 15
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6884
Practice Address - Country:US
Practice Address - Phone:956-725-4555
Practice Address - Fax:956-725-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX419363301Medicaid