Healthcare Provider Details

I. General information

NPI: 1346295300
Provider Name (Legal Business Name): JIMENEZ PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 N FRESNO ST SUITE 120
FRESNO CA
93710-5274
US

IV. Provider business mailing address

6011 N FRESNO ST SUITE 120
FRESNO CA
93710-5274
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-8155
  • Fax: 559-436-8165
Mailing address:
  • Phone: 559-436-8155
  • Fax: 559-436-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20417
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24895
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20718
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL JOHN JIMENEZ
Title or Position: PRESIDENT
Credential: PT
Phone: 559-436-8155