Provider Demographics
NPI:1477508059
Name:JIMENEZ, WILMARI (PT)
Entity Type:Individual
Prefix:
First Name:WILMARI
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
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:PO BOX 1374
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-7002
Mailing Address - Country:US
Mailing Address - Phone:787-859-8854
Mailing Address - Fax:787-859-8854
Practice Address - Street 1:12 CALLE NUEVA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1942
Practice Address - Country:US
Practice Address - Phone:787-859-8854
Practice Address - Fax:787-859-8854
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR870053OtherMMM
PR2-1033OtherMCS
PR2643OtherFIRST MEDICAL
PR2-1033OtherMCS
PRS76491Medicare UPIN