Healthcare Provider Details

I. General information

NPI: 1750285409
Provider Name (Legal Business Name): MICHELLE JIMENEZ PT, DPT
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: MICHELLE COUTURE

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 MASSACHUSETTS AVE STE 101
NORTH ANDOVER MA
01845-4143
US

IV. Provider business mailing address

198 MASSACHUSETTS AVE STE 101
NORTH ANDOVER MA
01845-4143
US

V. Phone/Fax

Practice location:
  • Phone: 978-269-5194
  • Fax: 978-208-8486
Mailing address:
  • Phone: 978-269-5194
  • Fax: 978-208-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL22556
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: