Provider Demographics
NPI:1083040091
Name:AJ THERAPY CENTER INC
Entity Type:Organization
Organization Name:AJ THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YADENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-765-1511
Mailing Address - Street 1:6107 MEMORIAL HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4596
Mailing Address - Country:US
Mailing Address - Phone:813-644-7232
Mailing Address - Fax:813-443-4653
Practice Address - Street 1:4710 EISENHOWER BLVD STE C8
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6334
Practice Address - Country:US
Practice Address - Phone:813-402-2079
Practice Address - Fax:813-443-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X, 261QP2000X
FLMM31033261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy