Provider Demographics
NPI:1295306504
Name:GIMENEZ, RYAN CHRISTOPHER LOPEZ (PT)
Entity type:Individual
Prefix:MR
First Name:RYAN CHRISTOPHER
Middle Name:LOPEZ
Last Name:GIMENEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RYAN
Other - Middle Name:CHRISTOPHER
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2904 LAGUNA CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-8023
Mailing Address - Country:US
Mailing Address - Phone:502-531-3980
Mailing Address - Fax:
Practice Address - Street 1:12222 COIT RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2302
Practice Address - Country:US
Practice Address - Phone:972-979-6577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCP006406T225100000X
NCP20378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist