Provider Demographics
NPI:1609383637
Name:FLORES, JAIME IVAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:IVAN
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WEST FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5850
Mailing Address - Country:US
Mailing Address - Phone:817-335-3440
Mailing Address - Fax:
Practice Address - Street 1:2500 WEST FWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5850
Practice Address - Country:US
Practice Address - Phone:817-335-3440
Practice Address - Fax:817-810-9669
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13009562251N0400X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology