Provider Demographics
NPI:1962684746
Name:HOME STAR PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:HOME STAR PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-280-4783
Mailing Address - Street 1:39 CALLE LOYOLA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7018
Mailing Address - Country:US
Mailing Address - Phone:949-280-4783
Mailing Address - Fax:949-429-2319
Practice Address - Street 1:39 CALLE LOYOLA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-7018
Practice Address - Country:US
Practice Address - Phone:949-280-4783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty