Provider Demographics
NPI:1497627905
Name:ABSOOD, JIMMYE
Entity type:Individual
Prefix:
First Name:JIMMYE
Middle Name:
Last Name:ABSOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16156 HARMONY RANCH DR
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:CA
Mailing Address - Zip Code:95315-9390
Mailing Address - Country:US
Mailing Address - Phone:209-238-5079
Mailing Address - Fax:
Practice Address - Street 1:18800 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:CA
Practice Address - Zip Code:95321-9470
Practice Address - Country:US
Practice Address - Phone:209-562-4035
Practice Address - Fax:209-962-5399
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52967225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant