Gary Pevnick, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

00394 Issued in MO

Practice address

12655 W Jefferson Blvd FL 4
Los Angeles, CA 90066-7008

Phone

(310) 907-9215

Fax

(310) 953-3281

NPI assigned

Jul 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• House Call Doctors, LLC

  • Optometrist
  • Saint Louis, MO
  • NPI 1871535419
  NPD (past) Authorized official

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1245260769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 QUARTERDECK ST APT 3",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926700",
            "telephone_number": "314-570-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12655 W JEFFERSON BLVD FL 4",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900667008",
            "telephone_number": "310-907-9215",
            "fax_number": "310-953-3281"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2865 Netherton Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631364674",
            "country_code": "US",
            "telephone_number": "314-653-0918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEVNICK",
        "first_name": "GARY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "00394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ernestine R Petty, M.D.
• Jadah Marie Sun Petty, PH.D.
• Jennifer Petty
• Rosalyn June Petty, OTR L
• Giselle Maria Petzinger, M.D.
• Joshua Pevnick, MD
• Lauren Alana Pevnick, RN
• Zachary David Pevnick, DPT
• Dimitrios Pexaras
• Parham Peyda, PHD

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, 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 29, 2020; 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.