Provider Demographics
NPI:1457649618
Name:JIMENEZ, GENARO ARAL (PT)
Entity Type:Individual
Prefix:
First Name:GENARO
Middle Name:ARAL
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39420 LIBERTY ST
Mailing Address - Street 2:SUITE 173A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2200
Mailing Address - Country:US
Mailing Address - Phone:510-358-2071
Mailing Address - Fax:510-358-2248
Practice Address - Street 1:39420 LIBERTY ST
Practice Address - Street 2:SUITE 173A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2200
Practice Address - Country:US
Practice Address - Phone:510-358-2071
Practice Address - Fax:510-358-2248
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist