Provider Demographics
NPI:1942987938
Name:PIMENTEL, PIM GRACE DAGATAN (PT)
Entity type:Individual
Prefix:MS
First Name:PIM GRACE
Middle Name:DAGATAN
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:PIM GRACE
Other - Middle Name:PIMENTEL
Other - Last Name:CULTURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:252 PARADISE PKWY
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8244
Mailing Address - Country:US
Mailing Address - Phone:331-725-4868
Mailing Address - Fax:
Practice Address - Street 1:252 PARADISE PKWY
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8244
Practice Address - Country:US
Practice Address - Phone:331-725-4868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015059A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist