MEDICARE: PATTY PASTOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1003966698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTY PASTOR

Provider Business Mailing Address
First Line	:	1051 DRY GULCH TRAIL DR
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-9121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 DRY GULCH TRAIL DR
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-9121
Country	:	US
Telephone Number	:	530-743-8933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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Directions to “ PATTY PASTOR ” Practice Location

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