Individual provider Active NPI

Ely Pastoral, PT

  • Physical Therapist
  • Anaheim, CA
National Provider Identifier
1104350321
Registry record updated Apr 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
35994 Issued in CA
Practice address
361 N Bellarose Way
Anaheim, CA 92805-3347
Phone
(646) 247-9699
NPI assigned
Apr 13, 2017
Last updated
Apr 13, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 35994 CA Primary
Physical Therapist 225100000X 070014826 IL

Addresses

Primary practice location

361 N Bellarose Way
Anaheim, CA 92805-3347

Mailing address

361 N Bellarose Way
Anaheim, CA 92805-3347
Phone (646) 247-9699

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
070014826ILMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492041600000",
    "number": "1104350321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 N BELLAROSE WAY",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928053347",
            "telephone_number": "646-247-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 N BELLAROSE WAY",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928053347",
            "telephone_number": "646-247-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASTORAL",
        "first_name": "ELY",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-13",
        "last_updated": "2017-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "35994",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070014826",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; 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.