Healthcare Provider Details

I. General information

NPI: 1679751804
Provider Name (Legal Business Name): NORTHERN STAR THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 19TH ST S SUITE 202
SARTELL MN
56377-4654
US

IV. Provider business mailing address

251 COUNTY ROAD 120 SUITE A
SAINT CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-257-2225
  • Fax: 320-257-2226
Mailing address:
  • Phone: 320-259-5429
  • Fax: 320-240-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL WEAVER
Title or Position: CEO
Credential: PT
Phone: 320-240-6955