Organization
NORTHERN STAR THERAPY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN WEAVER PT (CEO)
(320) 240-6955
Entity
Organization
Contact information
Practice address
251 COUNTY ROAD 120, SUITE A, SAINT CLOUD, MN 56303
(320) 259-5429
(320) 240-8905
Mailing address
251 COUNTY ROAD 120, SUITE A, SAINT CLOUD, MN 56303
(320) 259-5429
(320) 240-8905
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234211100
—
MN
01
—
264M1NO
BLUE CROSS BLUE SHIELD OF MN
MN
01
—
4G183NO
BLUE CROSS BLUE SHIELD OF MN
MN
01
—
6B481NO
BLUE CROSS BLUE SHIELD OF MN
MN
05
—
748070900
—
MN
Enumeration date
06/14/2006
Last updated
03/30/2010
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