Provider Demographics
NPI:1043571946
Name:JIMENEZ, RIA ESPERANZA DE LEON (PT)
Entity Type:Individual
Prefix:MISS
First Name:RIA ESPERANZA
Middle Name:DE LEON
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-3804
Mailing Address - Country:US
Mailing Address - Phone:630-873-0108
Mailing Address - Fax:
Practice Address - Street 1:3125 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-3804
Practice Address - Country:US
Practice Address - Phone:630-873-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017807225100000X
NY031234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist