Mary Agnes Severino-Clemente, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT21507 Issued in CA

Practice address

11442 White Oak Ave
Granada Hills, CA 91344-3334

Phone

(818) 687-8981

Fax

(818) 435-2081

NPI assigned

Feb 5, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Agnes Clemente Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235278334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11442 WHITE OAK AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913443334",
            "telephone_number": "818-687-8981",
            "fax_number": "818-435-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11442 WHITE OAK AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913443334",
            "telephone_number": "818-687-8981",
            "fax_number": "818-435-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVERINO-CLEMENTE",
        "first_name": "MARY",
        "middle_name": "AGNES",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT21507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "PT21507",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AGNES",
            "last_name": "CLEMENTE",
            "prefix": "MRS.",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Therapist in Granada Hills, CA
• Providers in Granada Hills, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.