Provider Demographics
NPI:1740792084
Name:KLEVA, JAMEY
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:
Last Name:KLEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13465 BECKWITH DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8338
Mailing Address - Country:US
Mailing Address - Phone:317-670-7886
Mailing Address - Fax:
Practice Address - Street 1:2647 WATERFRONT PARKWAY EAST DR STE WF3-185
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2061
Practice Address - Country:US
Practice Address - Phone:317-670-7886
Practice Address - Fax:317-536-3629
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001301225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant