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General NPI Number Information
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NPI Number | 1174129340
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Entity Type | Organization
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Legal Business Name | BRIGHT STAR THERAPY INC
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 1500 1ST AVE NE STE 100
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City | ROCHESTER
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State | MN
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Zip | 55906-4170
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Country | US
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Telephone | 612-990-8631
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Fax | 612-886-2618
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Provider Business Mailing Address
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Address Line | 1500 1ST AVE NE STE 100
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City | ROCHESTER
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State | MN
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Zip | 55906-4170
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Country | US
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Telephone | 612-990-8631
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Fax | 612-886-2618
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Authorized Official
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Title or Position | OWNER
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Name | ABDIRAHMAN MOHAMED SR.
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Credential |
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Telephone | 612-990-8631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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