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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200362680A
—
KS
05
—
53283589
—
CO
01
—
DE2582
RR MEDICARE
CO
01
—
DE2582
RR MEDICARE
KS
Enumeration date
08/15/2005
Last updated
08/06/2009
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