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Organization
STAR REHAB PROF PHYSICIANS, LLC
Active
Organization
STAR REHAB PROF PHYSICIANS, LLC
Active
Other names
Star Rehab, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA MARIKO TSUHA (COO)
(719) 561-5377
Entity
Organization
Contact information
Practice address
201 S MCCULLOCH BLVD, PUEBLO WEST, CO 81007-2892
(719) 561-5377
Mailing address
PO BOX 8867, PUEBLO, CO 81008-8867
(719) 561-5377
(719) 561-5378
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
44011
CO
208100000X
Physical Medicine & Rehabilitation Physician
31344
KS
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
04-31652
KS
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
39112
CO
Other
Enumeration date
08/15/2005
Last updated
08/06/2009
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