Provider Demographics
NPI:1780723999
Name:JIMENEZ, CRUZ III (PT)
Entity type:Individual
Prefix:MR
First Name:CRUZ
Middle Name:
Last Name:JIMENEZ
Suffix:III
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1083665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2669OtherBLUE CROSS BLUE SHIELD
TX8F0092Medicare PIN