Active NPI
Jordan Alexander Clevenger, DPT
- Physical Therapist
- Twentynine Palms, CA
National Provider Identifier
1164076568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT296699
- Practice address
- 5930 Adobe Rd
Twentynine Palms, CA 92277-2356 - Phone
- (760) 367-1743
- NPI assigned
- Jul 25, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT296699 | CA | Primary |
Addresses
Primary practice location
5930 Adobe Rd
Twentynine Palms, CA 92277-2356
Mailing address
10876 Cold Spring Dr
Fishers, IN 46038-2532
Phone (317) 308-9616
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 |
|---|---|---|---|
| PT296699 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564012800000",
"number": "1164076568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10876 COLD SPRING DR",
"city": "FISHERS",
"state": "IN",
"postal_code": "460382532",
"telephone_number": "317-308-9616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5930 ADOBE RD",
"city": "TWENTYNINE PALMS",
"state": "CA",
"postal_code": "922772356",
"telephone_number": "760-367-1743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENGER",
"first_name": "JORDAN",
"middle_name": "ALEXANDER",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-25",
"last_updated": "2019-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT296699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twentynine Palms, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.