Active NPI
Paul Alvin Clavecilla
- Geriatric Physical Therapist
- Crown Point, IN
National Provider Identifier
1710433008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 070020612
- Practice address
- 1099 South Main St.
Apt. 314
Crown Point, IN 46307 - Phone
- (847) 942-9143
- NPI assigned
- Aug 28, 2016
- 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 070020612 | IL | Primary |
Addresses
Primary practice location
1099 South Main St.
Apt. 314
Crown Point, IN 46307
Mailing address
1099 S Main St
Apt. 314
Crown Point, IN 46307-4851
Phone (847) 942-9143
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070020612 | IL | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472342400000",
"number": "1710433008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1099 S MAIN ST",
"address_2": "APT. 314",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463074851",
"telephone_number": "847-942-9143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1099 SOUTH MAIN ST.",
"address_2": "APT. 314",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "46307",
"telephone_number": "847-942-9143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLAVECILLA",
"first_name": "PAUL ALVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-28",
"last_updated": "2016-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "IL",
"license": "070020612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crown Point, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.