Individual
SHELBY RAE JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3190 E MERIDIAN PARK LOOP STE 206A, WASILLA, AK 99654-7422
(907) 373-9462
(907) 373-9463
Mailing address
4130 N PRESTON AVE, WASILLA, AK 99654-1352
(907) 414-4392
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116806
AK
Other
Enumeration date
08/20/2018
Last updated
08/20/2018
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