Provider Demographics
NPI:1164028619
Name:JIMENEZ, JASPER ESPIGADERA (PTA)
Entity Type:Individual
Prefix:
First Name:JASPER
Middle Name:ESPIGADERA
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 OLD MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2830
Mailing Address - Country:US
Mailing Address - Phone:347-606-6613
Mailing Address - Fax:
Practice Address - Street 1:1008 OLD MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2830
Practice Address - Country:US
Practice Address - Phone:347-606-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant