Provider Demographics
NPI:1942514906
Name:CLEVENGER, JAIME KANA (PT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:KANA
Last Name:CLEVENGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E DEL MAR BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2544
Mailing Address - Country:US
Mailing Address - Phone:626-564-2700
Mailing Address - Fax:626-564-2770
Practice Address - Street 1:200 E DEL MAR BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2544
Practice Address - Country:US
Practice Address - Phone:626-564-2700
Practice Address - Fax:626-564-2770
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331982251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics