Healthcare Provider Details

I. General information

NPI: 1659615516
Provider Name (Legal Business Name): CARLOS J JIMENEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 07/30/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MDG, 275 S. ASPEN ST. STOP 89
BUCKLEY SFB CO
80011
US

IV. Provider business mailing address

460 MDG, 275 S. ASPEN ST. STOP 89
BUCKLEY SFB CO
80011
US

V. Phone/Fax

Practice location:
  • Phone: 720-847-9292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0015227
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: