Active NPI
Paul Vanderstarre
- Physical Therapy Assistant
- Zeeland, MI
National Provider Identifier
1306405873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502003195
- Practice address
- 1375 Steaders Pass
Zeeland, MI 49464-1451 - Phone
- (616) 450-9521
- NPI assigned
- Jun 10, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502003195 | MI | Primary |
Addresses
Primary practice location
1375 Steaders Pass
Zeeland, MI 49464-1451
Mailing address
1375 Steaders Pass
Zeeland, MI 49464-1451
Phone (616) 450-9521
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | HomeOffice | Direct |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5502003195 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560124800000",
"number": "1306405873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1375 STEADERS PASS",
"city": "ZEELAND",
"state": "MI",
"postal_code": "494641451",
"telephone_number": "616-450-9521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1375 STEADERS PASS",
"city": "ZEELAND",
"state": "MI",
"postal_code": "494641451",
"telephone_number": "616-450-9521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERSTARRE",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-10",
"last_updated": "2019-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502003195",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "HomeOffice",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1375 Steaders Pass",
"city": "Zeeland",
"state": "MI",
"country_code": "US",
"postal_code": "494641451",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Zeeland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.