Healthcare Provider Details

I. General information

NPI: 1386751253
Provider Name (Legal Business Name): GEORGE PASTEUR JR. D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 WILLIS ST
WESTMINSTER MD
21157-5133
US

IV. Provider business mailing address

174 WILLIS ST
WESTMINSTER MD
21157-5133
US

V. Phone/Fax

Practice location:
  • Phone: 240-372-0614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18685
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204436
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22353
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT870101
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: