Provider Demographics
NPI:1104034495
Name:SAPP, JIMMY (LMT)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:SAPP
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-431-7246
Mailing Address - Fax:954-434-8104
Practice Address - Street 1:6522 E CARONDELET DR STE C
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2197
Practice Address - Country:US
Practice Address - Phone:549-802-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT272172081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine