MEDICARE: MRS. JESSICA SIMON JIMENEZ PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	07745	LA

General Provider Information

NPI Number	:	1477880656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA SIMON JIMENEZ PT, DPT

Provider Business Mailing Address
First Line	:	109 THOMAS OAK DR
Second Line	:
City	:	CHURCH POINT
State	:	LA
Zip	:	70525-5916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 ODD FELLOWS RD UNIT H-1
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526-2200
Country	:	US
Telephone Number	:	337-788-1480
Fax Number	:	337-788-0354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	04/07/2020

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