Provider Demographics
NPI:1710400056
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 HIGHLAND CREEK
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:617-796-8387
Mailing Address - Street 1:255 WASHINGTON ST STE 230
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1644
Mailing Address - Country:US
Mailing Address - Phone:617-796-8350
Mailing Address - Fax:
Practice Address - Street 1:6101 CLARKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6936
Practice Address - Country:US
Practice Address - Phone:704-947-8050
Practice Address - Fax:704-948-5106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-19
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy