NORTHERN STAR THERAPY LTD

Provider Demographics

• NPI: 1598778755
• Name: NORTHERN STAR THERAPY LTD
• Entity Type: Organization
• Organization Name: NORTHERN STAR THERAPY LTD
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: DAN
• Authorized Official - Last Name: WEAVER
• Authorized Official - Credentials: PT
• 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
• Mailing Address - Country: US
• Mailing Address - Phone: 320-259-5429
• Mailing Address - Fax: 320-240-8905
• Practice Address - Street 1: 1301 33RD ST S
• Practice Address - Street 2: SUITE 210
• Practice Address - City: SAINT CLOUD
• Practice Address - State: MN
• Practice Address - Zip Code: 56301-9668
• Practice Address - Country: US
• Practice Address - Phone: 320-240-6955
• Practice Address - Fax: 320-240-8089
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-15
• Last Update Date: 2010-03-30

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MN	234211100	Medicaid
MN	264M1NO	Other	BLUE CROSS BLUE SHIELD OF MN
MN	4G183NO	Other	BLUE CROSS BLUE SHIELD OF MN
MN	6B481NO	Other	BLUE CROSS BLUE SHIELD OFMN
MN	398814700	Medicaid
MN	C04274	Medicare PIN
MN	1093560001	Medicare NSC
MN	264M1NO	Other	BLUE CROSS BLUE SHIELD OF MN
MN	4G183NO	Other	BLUE CROSS BLUE SHIELD OF MN
MN	234211100	Medicaid
MN	1093560003	Medicare NSC
MN	C02592	Medicare PIN