Active NPI
Stephanie Van Iderstine
- Physical Therapy Assistant
- East Longmeadow, MA
National Provider Identifier
1710420104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 9202
- Practice address
- 305 Maple St
East Longmeadow, MA 01028-2765 - Phone
- (413) 525-6361
- NPI assigned
- Dec 2, 2016
- 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 Therapy Assistant | 225200000X | 9202 | MA | Primary |
Addresses
Primary practice location
305 Maple St
East Longmeadow, MA 01028-2765
Mailing address
305 Maple St
East Longmeadow, MA 01028-2765
Other names 1
- Stephanie Pool
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 |
|---|---|---|---|
| 9202 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480636800000",
"number": "1710420104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 MAPLE ST",
"city": "EAST LONGMEADOW",
"state": "MA",
"postal_code": "010282765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 MAPLE ST",
"city": "EAST LONGMEADOW",
"state": "MA",
"postal_code": "010282765",
"telephone_number": "413-525-6361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN IDERSTINE",
"first_name": "STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-02",
"last_updated": "2016-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "9202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "POOL",
"code": "1",
"type": "Former Name"
}
]
}Other providers in East Longmeadow, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.