Healthcare Provider Details

I. General information

NPI: 1982360095
Provider Name (Legal Business Name): PIA JIMENO LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 B ST STE 102
CHESAPEAKE VA
23324-2462
US

IV. Provider business mailing address

PO BOX 412307
BOSTON MA
02241-2307
US

V. Phone/Fax

Practice location:
  • Phone: 757-548-0014
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604741
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: