Provider Demographics
NPI:1275508400
Name:CLOVER, JAMES BAUMAN JR (MED, ATC, PTA)
Entity Type:Individual
Prefix:MS
First Name:JAMES
Middle Name:BAUMAN
Last Name:CLOVER
Suffix:JR
Gender:M
Credentials:MED, ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 BEECHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1217
Mailing Address - Country:US
Mailing Address - Phone:951-274-3484
Mailing Address - Fax:951-274-3599
Practice Address - Street 1:4444 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4136
Practice Address - Country:US
Practice Address - Phone:951-274-3484
Practice Address - Fax:951-274-3599
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07802652225200000X
7901982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant