Provider Demographics
NPI:1215414420
Name:JAVIER, JIMMY PENTINIO (PT)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:PENTINIO
Last Name:JAVIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 IMPERIAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7204
Mailing Address - Country:US
Mailing Address - Phone:915-203-3306
Mailing Address - Fax:
Practice Address - Street 1:7116 IMPERIAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7204
Practice Address - Country:US
Practice Address - Phone:915-203-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist