Provider Demographics
NPI:1366944944
Name:JIMENEZ, KRISTINA MARIA (DPT, PT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1246
Mailing Address - Country:US
Mailing Address - Phone:201-600-6378
Mailing Address - Fax:
Practice Address - Street 1:608 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5170
Practice Address - Country:US
Practice Address - Phone:201-484-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01778900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist