Provider Demographics
NPI:1265067235
Name:JIMENEZ, JESSICA CORIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CORIN
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 1:1408 SE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5332
Mailing Address - Country:US
Mailing Address - Phone:863-801-7956
Mailing Address - Fax:
Practice Address - Street 1:10099 SEMINOLE BLVD STE A5
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2540
Practice Address - Country:US
Practice Address - Phone:727-399-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist