Provider Demographics
NPI:1972514867
Name:S.T.A.R. THERAPY CLINIC, INC
Entity type:Organization
Organization Name:S.T.A.R. THERAPY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BROWNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-449-9394
Mailing Address - Street 1:7726 N. FIRST ST. #118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-449-9394
Mailing Address - Fax:559-449-8287
Practice Address - Street 1:6121 N THESTA ST
Practice Address - Street 2:SUITE 115
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8603
Practice Address - Country:US
Practice Address - Phone:559-449-9394
Practice Address - Fax:559-449-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21079ZMedicare ID - Type Unspecified