Provider Demographics
NPI:1699806687
Name:JIMENEZ, GRACE (PT)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:GRACE
Other - Middle Name:REYES
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:6237 SPRING KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-6864
Mailing Address - Country:US
Mailing Address - Phone:717-651-7791
Mailing Address - Fax:717-651-7791
Practice Address - Street 1:6237 SPRING KNOLL DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-6864
Practice Address - Country:US
Practice Address - Phone:717-651-7791
Practice Address - Fax:717-651-7791
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008705L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist