Keishla Jimenez Nieves, PT, DPT – Physical Therapist

Key facts

NPI: 1346909330
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: PT36359 (FL)
Practice address: 3127 US Highway 98 N
Lakeland, FL 33805-2103
Phone: (863) 665-8881
NPI assigned: Dec 17, 2021
Sex: Female
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Cora Health Services Inc Rehabilitation Clinic/Center · Lakeland, FL · NPI 1790718963

NPD (past)
Cora Health Services, Inc Rehabilitation Clinic/Center · Winter Garden, FL · NPI 1104786805

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
PT36359	FL	MD	Physical Therapist

Practice roles (2 of 4)

Organization	Specialty	Status	New patients
Cora Health Services Inc		Past since Dec 21, 2021	Accepting new patients
Cora Health Services, Inc		Past since Dec 21, 2021	Accepting new patients

Networks

Optimum HealthCare HMO Network
Freedom Health HMO Network

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	PT36359	FL	Yes

Addresses

Primary practice location

3127 US Highway 98 N
Lakeland, FL 33805-2103

Mailing address

3127 US Highway 98 N
Lakeland, FL 33805-2103

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 17, 2021.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1346909330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3127 US HIGHWAY 98 N",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338052103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3127 US HIGHWAY 98 N",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338052103",
            "telephone_number": "863-665-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ NIEVES",
        "first_name": "KEISHLA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-17",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT36359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

All providers in Lakeland, FL · Physical Therapist in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.