Provider Demographics
NPI:1639825631
Name:FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC
Other - Org Name:AGEILITY PHYSICAL THERAPY SOLUTIONS AT 75 STATE STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8350
Mailing Address - Street 1:225 WASHINGTON ST # 230
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1726
Mailing Address - Country:US
Mailing Address - Phone:617-796-8350
Mailing Address - Fax:
Practice Address - Street 1:75 STATE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3746
Practice Address - Country:US
Practice Address - Phone:207-775-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-28
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy