Provider Demographics
NPI:1346295300
Name:JIMENEZ PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:JIMENEZ PHYSICAL THERAPY, INC
Other - Org Name:JIMENEZ PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-436-8155
Mailing Address - Street 1:6011 N FRESNO ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5274
Mailing Address - Country:US
Mailing Address - Phone:559-436-8155
Mailing Address - Fax:559-436-8165
Practice Address - Street 1:6011 N FRESNO ST
Practice Address - Street 2:SUITE 120
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5274
Practice Address - Country:US
Practice Address - Phone:559-436-8155
Practice Address - Fax:559-436-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20417225100000X
CAPT24895225100000X
CAPT20718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty