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General NPI Number Information
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NPI Number | 1063225837
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Entity Type | Organization
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Legal Business Name | NORTH STAR PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 552 MAIN ST
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City | CARIBOU
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State | ME
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Zip | 04736-4404
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Country | US
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Telephone | 207-498-9507
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Fax |
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Provider Business Mailing Address
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Address Line | 271 VAN BUREN RD
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City | CARIBOU
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State | ME
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Zip | 04736-3568
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Country | US
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Telephone | 207-498-9507
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Fax |
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | RAINALD GERVAIS III
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Credential |
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Telephone | 207-498-9507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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