Healthcare Provider Details

I. General information

NPI: 1992544399
Provider Name (Legal Business Name): CARMEN DANIELLE PASTOR MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SPORTSMAN DR STE 10
CLARION PA
16214-8572
US

IV. Provider business mailing address

PO BOX 204
SALINA PA
15680-0204
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-1356
  • Fax:
Mailing address:
  • Phone: 724-689-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT008284
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: