Provider Demographics
NPI:1407867039
Name:GALIMBA, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:GALIMBA
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 1:557 N JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2806
Mailing Address - Country:US
Mailing Address - Phone:870-562-1042
Mailing Address - Fax:
Practice Address - Street 1:1010 N DUDNEY RD
Practice Address - Street 2:SUITE D
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2624
Practice Address - Country:US
Practice Address - Phone:870-299-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist