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General NPI Number Information
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NPI Number | 1659615516
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Entity Type | Individual
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Provider Name | CARLOS J JIMENEZ DPT
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Gender | Male
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 460 MDG, 275 S. ASPEN ST. STOP 89
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City | BUCKLEY SFB
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State | CO
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Zip | 80011
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Country | US
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Telephone | 720-847-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 460 MDG, 275 S. ASPEN ST. STOP 89
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City | BUCKLEY SFB
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State | CO
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Zip | 80011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0015227
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License Number State | CO
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