Provider Demographics
NPI:1659615516
Name:JIMENEZ, CARLOS J (DPT)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MDG, 275 S. ASPEN ST. STOP 89
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY SFB
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 MDG, 275 S. ASPEN ST. STOP 89
Practice Address - Street 2:
Practice Address - City:BUCKLEY SFB
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:720-847-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3841Medicare UPIN