Provider Demographics
NPI:1134256076
Name:AVE, JIM S (ATC)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:S
Last Name:AVE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7786 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3623
Mailing Address - Country:US
Mailing Address - Phone:559-322-5911
Mailing Address - Fax:559-453-7182
Practice Address - Street 1:1717 S CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-4709
Practice Address - Country:US
Practice Address - Phone:559-453-7186
Practice Address - Fax:559-453-7182
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer