Provider Demographics
NPI:1629117825
Name:JIMENEZ PHYSICAL THERAPY, P.L.L.C.
Entity Type:Organization
Organization Name:JIMENEZ PHYSICAL THERAPY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:210-767-1722
Mailing Address - Street 1:6794 INGRAM RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-4101
Mailing Address - Country:US
Mailing Address - Phone:210-767-1722
Mailing Address - Fax:210-767-0795
Practice Address - Street 1:6794 INGRAM RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4101
Practice Address - Country:US
Practice Address - Phone:210-767-1722
Practice Address - Fax:210-767-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1083665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030LJOtherBLUE CROSS BLUE SHIELD
TX00851YMedicare PIN