Provider Demographics
NPI:1275856304
Name:NORTHERN STAR THERAPY LTD
Entity Type:Organization
Organization Name:NORTHERN STAR THERAPY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-240-6955
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4872
Mailing Address - Country:US
Mailing Address - Phone:320-259-5429
Mailing Address - Fax:320-240-8905
Practice Address - Street 1:2395 TROOP DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4694
Practice Address - Country:US
Practice Address - Phone:320-258-3022
Practice Address - Fax:320-258-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4G183NOOtherBLUE CROSS BLUE SHIELD OF MN
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN6B481NOOtherBLUE CROSS BLUE SHIELD OF MN