Provider Demographics
NPI:1326590555
Name:JIMENEZ, MARCOS
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 SW 29TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4712
Mailing Address - Country:US
Mailing Address - Phone:954-342-9333
Mailing Address - Fax:954-391-9155
Practice Address - Street 1:14601 SW 29TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4712
Practice Address - Country:US
Practice Address - Phone:954-342-9333
Practice Address - Fax:954-391-9155
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist