Provider Demographics
NPI:1992544399
Name:PASTOR, CARMEN DANIELLE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:DANIELLE
Last Name:PASTOR
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:PA
Mailing Address - Zip Code:15680-0204
Mailing Address - Country:US
Mailing Address - Phone:724-689-6705
Mailing Address - Fax:
Practice Address - Street 1:18 SPORTSMAN DR STE 10
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8572
Practice Address - Country:US
Practice Address - Phone:814-226-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0082842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer