Shining Star Children's Therapy, Inc

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

20271 Issued in CA

Legal business name

SHINING STAR CHILDREN'S THERAPY, INC

Practice address

4287 Sly Park Rd
Pollock Pines, CA 95726-9007

Phone

(866) 306-3469

Fax

(866) 615-6143

NPI assigned

Apr 2, 2014

Last updated

Apr 2, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeanne Marie Conca, MPT

Title

Owner/Therapist

Phone

(530) 306-3469

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396396800000",
    "number": "1265850663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34120",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895334120",
            "telephone_number": "775-747-5050",
            "fax_number": "775-747-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4287 SLY PARK RD",
            "city": "POLLOCK PINES",
            "state": "CA",
            "postal_code": "957269007",
            "telephone_number": "866-306-3469",
            "fax_number": "866-615-6143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING STAR CHILDREN'S THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-02",
        "last_updated": "2014-04-02",
        "status": "A",
        "authorized_official_last_name": "CONCA",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "530-306-3469",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "20271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "20271",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Physical Therapist in Pollock Pines, CA
• Providers in Pollock Pines, CA by specialty
• Pediatric Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.