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General NPI Number Information
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NPI Number | 1821872664
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Entity Type | Individual
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Provider Name | RAY JIMENEZ
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Gender | Male
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 3 INDUSTRIAL WAY E
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City | EATONTOWN
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State | NJ
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Zip | 07724-3318
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Country | US
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Telephone | 732-544-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 GRANT ST
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City | HERNDON
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State | VA
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Zip | 20170-3012
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | CP032270A
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306606386
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License Number State | VA
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