Provider Demographics
NPI:1669583373
Name:FIVE STAR PHYSICAL THERAPY
Entity type:Organization
Organization Name:FIVE STAR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SERLO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:904-710-3730
Mailing Address - Street 1:236 PONTE VEDRA PARK DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082
Mailing Address - Country:US
Mailing Address - Phone:904-280-3440
Mailing Address - Fax:904-280-3444
Practice Address - Street 1:236 PONTE VEDRA PARK DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-280-3440
Practice Address - Fax:904-280-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation