Healthcare Provider Details

I. General information

NPI: 1780549048
Provider Name (Legal Business Name): JAKE THOMAS ZIMINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 DEBBIE DR
MARION TX
78124-1641
US

IV. Provider business mailing address

4350 RED CAP DR
SAN ANTONIO TX
78222-4821
US

V. Phone/Fax

Practice location:
  • Phone: 210-324-5988
  • Fax:
Mailing address:
  • Phone: 210-324-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number145659
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: