Provider Demographics
NPI:1306439617
Name:JIMENEZ IRWIN, FALON MELISSA (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:FALON
Middle Name:MELISSA
Last Name:JIMENEZ IRWIN
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1197
Mailing Address - Country:US
Mailing Address - Phone:609-867-9353
Mailing Address - Fax:
Practice Address - Street 1:2963 TRAVERSE TRL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2017
Practice Address - Country:US
Practice Address - Phone:352-254-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01993100225100000X
FL39506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty