Provider Demographics
NPI:1477880656
Name:JIMENEZ, JESSICA SIMON (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SIMON
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 THOMAS OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-5916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:753 ODD FELLOWS RD UNIT H-1
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2200
Practice Address - Country:US
Practice Address - Phone:337-788-1480
Practice Address - Fax:337-788-0354
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist