Provider Demographics
NPI:1083191498
Name:ROTON, JIMMY LEWIS JR (MS, LAT/ATC, PES, CE)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:LEWIS
Last Name:ROTON
Suffix:JR
Gender:M
Credentials:MS, LAT/ATC, PES, CE
Other - Prefix:
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Mailing Address - Street 1:1851 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4347
Mailing Address - Country:US
Mailing Address - Phone:281-924-1316
Mailing Address - Fax:713-850-4114
Practice Address - Street 1:2401 CLAREMONT LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-5897
Practice Address - Country:US
Practice Address - Phone:713-850-0222
Practice Address - Fax:713-850-4114
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAT08692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer