Individual
STEPHANIE JIMERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
767 MINERAL SPRINGS RD, BUFFALO, NY 14224-1053
(716) 806-8210
Mailing address
25 GORSKI ST, BUFFALO, NY 14206-3514
(716) 806-8210
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
031945-01
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BW48793V
—
NY
Enumeration date
04/05/2023
Last updated
04/05/2023
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