Provider Demographics
NPI:1396704094
Name:STAR PHYSICAL THERAPY LP
Entity type:Organization
Organization Name:STAR PHYSICAL THERAPY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:866-800-9147
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:866-800-9147
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:5505 EDMONDSON PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5872
Practice Address - Country:US
Practice Address - Phone:615-831-1710
Practice Address - Fax:615-831-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid
TN0446631Medicaid