Basic Information
| Provider Information | |||||||||
| NPI: | 1861848483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASTOOR | ||||||||
| FirstName: | JANEEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CONRAN DR | ||||||||
| Address2: | |||||||||
| City: | COOPERSVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494041366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169976172 | ||||||||
| FaxNumber: | 6169652475 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 CONRAN DR | ||||||||
| Address2: | |||||||||
| City: | COOPERSVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494041366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169976172 | ||||||||
| FaxNumber: | 6169652475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2016 | ||||||||
| LastUpdateDate: | 05/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 7501003288 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7501003288 | 01 | MI | STATE OF MICHIGAN MASSAGE THERAPY LICENSE NUMBER | OTHER |