Active NPI
Paul Logronio Penoliar, OTR/L C/NDT
- Specialist
- Glendale, CA
National Provider Identifier
1134560386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OT6994
- Practice address
- 332 N Kenwood St Apt 4
Glendale, CA 91206-3549 - Phone
- (818) 472-9584
- NPI assigned
- Jul 16, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | OT6994 | CA | Primary |
Addresses
Primary practice location
332 N Kenwood St Apt 4
Glendale, CA 91206-3549
Mailing address
332 N Kenwood St Apt 4
Glendale, CA 91206-3549
Phone (818) 472-9584
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT6994 | CA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Re Active Physical Therapy and Wellness | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Neurology Physical Therapist
- Los Angeles, CA
- NPI 1952650475
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373932800000",
"number": "1134560386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "332 N KENWOOD ST APT 4",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912063549",
"telephone_number": "818-472-9584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "332 N KENWOOD ST APT 4",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912063549",
"telephone_number": "818-472-9584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENOLIAR",
"first_name": "PAUL",
"middle_name": "LOGRONIO",
"name_prefix": "Mr.",
"credential": "OTR/L C/NDT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-16",
"last_updated": "2013-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "OT6994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.