Healthcare Provider Details

I. General information

NPI: 1407765126
Provider Name (Legal Business Name): REDEMPTION PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17190 BERNARDO CENTER DR STE 200
SAN DIEGO CA
92128-7031
US

IV. Provider business mailing address

17190 BERNARDO CENTER DR STE 200
SAN DIEGO CA
92128-7031
US

V. Phone/Fax

Practice location:
  • Phone: 619-762-8707
  • Fax:
Mailing address:
  • Phone: 619-762-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ITZEL JIMENEZ
Title or Position: CEO
Credential: DPT
Phone: 623-433-6498