Provider Demographics
NPI:1346993524
Name:JIMENEZ, CATHERINE ANN (PTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20018 FLAX FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5379
Mailing Address - Country:US
Mailing Address - Phone:832-627-5854
Mailing Address - Fax:
Practice Address - Street 1:1406 N ALABAMA RD # B
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3308
Practice Address - Country:US
Practice Address - Phone:979-531-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2167515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant