Provider Demographics
NPI:1154409688
Name:PLEVIN, JOAN TERRY (PT, DC)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:TERRY
Last Name:PLEVIN
Suffix:
Gender:F
Credentials:PT, DC
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:TERRY
Other - Last Name:PLEVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:22431 GOLDRUSH
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4308
Mailing Address - Country:US
Mailing Address - Phone:949-380-1445
Mailing Address - Fax:949-380-7723
Practice Address - Street 1:22431 GOLDRUSH
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4308
Practice Address - Country:US
Practice Address - Phone:949-380-1445
Practice Address - Fax:949-380-7723
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT71002251X0800X, 2251E1200X
CADC16812111NR0400X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT71000OtherBLUE SHIELD