Provider Demographics
NPI:1164180345
Name:JIMENEZ, BIANCA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:LYNN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:LYNN
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:9710 HAWK ELM
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2536
Mailing Address - Country:US
Mailing Address - Phone:210-218-1476
Mailing Address - Fax:
Practice Address - Street 1:631 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4017
Practice Address - Country:US
Practice Address - Phone:830-625-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2097656225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant