Nicole Marie Pastoor, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

AT-6074 Issued in CA

Practice address

17615 W Moore
Grant, MI 49327-9408

Phone

(231) 834-0208

NPI assigned

Apr 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ivyrehab Northern PT, LLC

  • Physical Therapy Clinic/Center
  • Sparta, MI
  • NPI 1972592525
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376762997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5296 NEW HOLLAND ST",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494269565",
            "telephone_number": "616-813-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17615 W MOORE",
            "city": "GRANT",
            "state": "MI",
            "postal_code": "493279408",
            "telephone_number": "231-834-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASTOOR",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "AT-6074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Miller, RPH.
• Roberto Miller, PA-C
• Newaygo County General Hospital Association (Spectrum Health Gerber Memorial Family Medicine - Grant)
• Newaygo County General Hospital Association
• Heidi Parent-Leonard
• Kimberly Perez, DDS
• Robert Poehl, PA C
• Ray of Hope Counseling Services, PLLC
• Michelle Leigh Regan, PPCNP-BC
• Conard Deverl Reyburn

• Physical Therapy Assistant in Grant, MI
• Providers in Grant, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.