Provider Demographics
NPI:1427586528
Name:JIMENEZ, LAURA (LMP, PTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LMP, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 S 140TH ST # 101
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2098
Mailing Address - Country:US
Mailing Address - Phone:206-390-6786
Mailing Address - Fax:
Practice Address - Street 1:13050 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3047
Practice Address - Country:US
Practice Address - Phone:206-248-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60668168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist