Active NPI
Kevin Dale Ivey, P.T.
- Physical Therapist
- Grass Valley, CA
National Provider Identifier
1962596908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 20829
- Practice address
- 565 Brunswick Rd
Suite 4
Grass Valley, CA 95945-9529 - Phone
- (530) 273-4152
- Fax
- (530) 273-4153
- NPI assigned
- Oct 3, 2006
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 20829 | CA | Primary |
Addresses
Primary practice location
565 Brunswick Rd
Suite 4
Grass Valley, CA 95945-9529
Mailing address
565 Brunswick Rd
Suite 4
Grass Valley, CA 95945-9529
Phone (530) 273-4152
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20829 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368057600000",
"number": "1962596908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "565 BRUNSWICK RD",
"address_2": "SUITE 4",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959459529",
"telephone_number": "530-273-4152",
"fax_number": "530-273-4153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "565 BRUNSWICK RD",
"address_2": "SUITE 4",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959459529",
"telephone_number": "530-273-4152",
"fax_number": "530-273-4153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVEY",
"first_name": "KEVIN",
"middle_name": "DALE",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2013-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "20829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.