Provider Demographics
NPI:1750691226
Name:FIVE STAR PHYSICAL THERAPY AND SPORT MEDICINE, LLC
Entity type:Organization
Organization Name:FIVE STAR PHYSICAL THERAPY AND SPORT MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:405-810-2902
Mailing Address - Street 1:2601 EAST DANFORTH RD.
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034
Mailing Address - Country:US
Mailing Address - Phone:405-810-2902
Mailing Address - Fax:405-810-2905
Practice Address - Street 1:6801 NORHT CLASSEN BLVD.
Practice Address - Street 2:SUITE #B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-810-2902
Practice Address - Fax:405-810-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1296261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy