Organization
JIMENEZ REHABILITATION LLC
Active
Other names
Fountain Of Youth Therapies
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SIDNEY L JIMENEZ MM 45280 (LICENSED MEDICAL MASSAGE THERAPIST)
(407) 508-0768
Entity
Organization
Contact information
Practice address
1603 S HIAWASSEE RD STE 105, ORLANDO, FL 32835-6437
(407) 508-0768
Mailing address
1603 S HIAWASSEE RD STE 105, ORLANDO, FL 32835-6437
(407) 508-0768
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
—
—
163WM1400X
Nurse Massage Therapist (NMT)
—
—
225700000X
Massage Therapist
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
06/09/2023
Last updated
06/03/2024
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