Provider Demographics
NPI:1841231651
Name:STAR PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:STAR PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELSAYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASSANEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT, MSC
Authorized Official - Phone:630-353-1355
Mailing Address - Street 1:412 63RD ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2000
Mailing Address - Country:US
Mailing Address - Phone:630-353-1355
Mailing Address - Fax:630-353-1356
Practice Address - Street 1:412 63RD ST
Practice Address - Street 2:SUITE 108
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2000
Practice Address - Country:US
Practice Address - Phone:630-353-1355
Practice Address - Fax:630-353-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211096Medicare ID - Type Unspecified