Active NPI
Mariola Beata Vanderest, PT
- Physical Therapist
- Keego Harbor, MI
National Provider Identifier
1487843348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501005050
- Practice address
- 2141 Cass Lake Rd
Suite 107
Keego Harbor, MI 48320 - Phone
- (248) 706-1308
- Fax
- (248) 706-1049
- NPI assigned
- Oct 17, 2007
- Sex
- Female
- 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 Therapist | 225100000X | 5501005050 | MI | Primary |
Addresses
Primary practice location
2141 Cass Lake Rd
Suite 107
Keego Harbor, MI 48320
Mailing address
2141 Cass Lake Rd
Suite 107
Keego Harbor, MI 48320
Phone (248) 706-1308
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5501005050 | Other | MI | BOARD OF PHYSICAL THERAPY |
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 |
|---|---|---|---|
| 5501005050 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1487843348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2141 CASS LAKE RD",
"address_2": "SUITE 107",
"city": "KEEGO HARBOR",
"state": "MI",
"postal_code": "48320",
"telephone_number": "248-706-1308",
"fax_number": "248-706-1049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2141 CASS LAKE RD",
"address_2": "SUITE 107",
"city": "KEEGO HARBOR",
"state": "MI",
"postal_code": "48320",
"telephone_number": "248-706-1308",
"fax_number": "248-706-1049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDEREST",
"first_name": "MARIOLA",
"middle_name": "BEATA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-17",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501005050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHYSICAL THERAPY",
"identifier": "5501005050",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Keego Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.