Provider Demographics
NPI:1063225837
Name:NORTH STAR PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:NORTH STAR PEDIATRIC THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GERVAIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:207-498-9507
Mailing Address - Street 1:271 VAN BUREN RD
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-3568
Mailing Address - Country:US
Mailing Address - Phone:207-498-9507
Mailing Address - Fax:
Practice Address - Street 1:552 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-4404
Practice Address - Country:US
Practice Address - Phone:207-498-9507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty