Healthcare Provider Details

I. General information

NPI: 1275856304
Provider Name (Legal Business Name): NORTHERN STAR THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 TROOP DR SUITE 102
SARTELL MN
56377-4694
US

IV. Provider business mailing address

251 COUNTY ROAD 120 SUITE A
SAINT CLOUD MN
56303-4872
US

V. Phone/Fax

Practice location:
  • Phone: 320-258-3022
  • Fax: 320-258-0389
Mailing address:
  • Phone: 320-259-5429
  • Fax: 320-240-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAN WEAVER
Title or Position: CEO
Credential:
Phone: 320-240-6955