Active NPI
Jaime Kana Clevenger, PT
- Pediatric Physical Therapist
- Pasadena, CA
National Provider Identifier
1942514906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 33198
- Practice address
- 200 E del Mar Blvd
Suite 112
Pasadena, CA 91105-2544 - Phone
- (626) 564-2700
- Fax
- (626) 564-2770
- NPI assigned
- Aug 2, 2010
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 33198 | CA | Primary |
Addresses
Primary practice location
200 E del Mar Blvd
Suite 112
Pasadena, CA 91105-2544
Mailing address
200 E del Mar Blvd
Suite 112
Pasadena, CA 91105-2544
Phone (626) 564-2700
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 |
|---|---|---|---|
| 33198 | CA | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280707200000",
"number": "1942514906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E DEL MAR BLVD",
"address_2": "SUITE 112",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052544",
"telephone_number": "626-564-2700",
"fax_number": "626-564-2770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E DEL MAR BLVD",
"address_2": "SUITE 112",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052544",
"telephone_number": "626-564-2700",
"fax_number": "626-564-2770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENGER",
"first_name": "JAIME",
"middle_name": "KANA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-02",
"last_updated": "2010-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CA",
"license": "33198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.