Shooting Star Pediatric Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SHOOTING STAR PEDIATRIC PHYSICAL THERAPY LLC

Practice address

8120 Penn Ave S Ste 500C
Bloomington, MN 55431-1367

Phone

(952) 373-1180

NPI assigned

May 9, 2023

Last updated

May 9, 2023By 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

Lindsay Ann O'Mahoney, MPTNPI 1518080951

Title

Owner

Phone

(952) 373-1180

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lindsay Ann O'Mahoney, MPT

  • Physical Therapist
  • Bloomington, MN
  • NPI 1518080951
  NPD Authorized official

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

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1952091464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8120 PENN AVE S STE 500C",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311367",
            "telephone_number": "952-373-1180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 PENN AVE S STE 500C",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311367",
            "telephone_number": "952-373-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOOTING STAR PEDIATRIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-09",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "O'MAHONEY",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-373-1180",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.