# STAR REHAB PROF PHYSICIANS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Star Rehab, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922000421
- **Authorized official:** LYNDA MARIKO TSUHA (COO)
- **Authorized official phone:** (719) 561-5377

## Contact information

- **Practice address:** 201 S MCCULLOCH BLVD, PUEBLO WEST, CO 81007-2892
- **Practice address phone:** (719) 561-5377
- **Mailing address:** PO BOX 8867, PUEBLO, CO 81008-8867
- **Mailing address phone:** (719) 561-5377
- **Mailing address fax:** (719) 561-5378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | 39112 | CO | Yes |

## Other

- **Enumeration date:** 08/15/2005
- **Last updated:** 08/06/2009