Individual provider Active NPI

Kevin Lavertu, PT, DPT

  • Physical Therapist
  • San Dimas, CA
National Provider Identifier
1477359602
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
307644 Issued in CA
Practice address
1335 Cypress St Ste 100
San Dimas, CA 91773-3538
Phone
(909) 305-1383
NPI assigned
Feb 19, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 307644 CA Primary

Addresses

Primary practice location

1335 Cypress St Ste 100
San Dimas, CA 91773-3538

Mailing address

1335 Cypress St Ste 100
San Dimas, CA 91773-3538
Phone (909) 305-1383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250403001170 CA Practitioner - Physical Therapist in Private Practice 5597289280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covina Hills Sports Medicine IncGroup PAC ID 9335102300, 5 clinicians
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians

Practice addresses (Care Compare)

1335 Cypress St
Suite 100
San Dimas, CA 91773-3538
Phone (909) 305-1383

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Covina Hills Sports Medicine Inc Physical Therapist CurrentSince Feb 21, 2025 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Feb 6, 2026 Accepting new patients

Locations

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

1335 Cypress St
Ste 100
San Dimas, CA 91773
Phone (626) 331-6358

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1739923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1477359602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 CYPRESS ST STE 100",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733538",
            "telephone_number": "909-305-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 CYPRESS ST STE 100",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733538",
            "telephone_number": "909-305-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVERTU",
        "first_name": "KEVIN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-19",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "307644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.