| Organization Name: | SHINING STAR CHILDREN'S THERAPY, INC |
| NPI Number: | 1265850663 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEANNE MARIE CONCA (OWNER/THERAPIST) |
| Mailing Address: | 4287 Sly Park Rd Pollock Pines |
| State: | CA US |
| Postal Code: | 957269007 |
| Phone Number: | 8663063469 |
| Fax Number: | 8666156143 |
| NPI Enumeration Date: | 04/02/2014 |
| NPI Last Update Date: | 04/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 20271 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |