Jeanne Marie Nystrom

Key facts

NPI

1972156883

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

5501002905 (MI)

Practice address

23332 Red Arrow Hwy
Mattawan, MI 49071-9703

Phone

(269) 283-5349

NPI assigned

Jul 19, 2019

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 19, 2019.

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1972156883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 MARIGOLD AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490026251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23332 RED ARROW HWY",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490719703",
            "telephone_number": "269-283-5349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYSTROM",
        "first_name": "JEANNE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501002905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Mattawan, MI · Physical Therapist in Michigan