MEDICARE: JACOBRJ1 JIMENEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		TX

General Provider Information

NPI Number	:	1740135607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOBRJ1 JIMENEZ

Provider Business Mailing Address
First Line	:	12474 STARCREST DR APT 912
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17026 BULVERDE RD STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-4700
Country	:	US
Telephone Number	:	210-819-2994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ JACOBRJ1 JIMENEZ ” Practice Location

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