Provider Demographics
NPI:1861848483
Name:PASTOOR, JANEEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:JANEEN
Middle Name:
Last Name:PASTOOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CONRAN DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-1366
Mailing Address - Country:US
Mailing Address - Phone:616-997-6172
Mailing Address - Fax:616-965-2475
Practice Address - Street 1:25 CONRAN DR
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1366
Practice Address - Country:US
Practice Address - Phone:616-997-6172
Practice Address - Fax:616-965-2475
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003288225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501003288OtherSTATE OF MICHIGAN MASSAGE THERAPY LICENSE NUMBER