Healthcare Provider Details

I. General information

NPI: 1700831765
Provider Name (Legal Business Name): MICHAEL JOHN JIMENEZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 N FRESNO ST
FRESNO CA
93710-5237
US

IV. Provider business mailing address

535 W DECATUR AVE
CLOVIS CA
93611-6781
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 TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT20417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: