Provider Demographics
NPI:1215144142
Name:GRIMM, PATRICIA MARIE (PHD, RN, CMT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARIE
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PHD, RN, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 KENNETH SQ
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3011
Mailing Address - Country:US
Mailing Address - Phone:410-433-7985
Mailing Address - Fax:
Practice Address - Street 1:428 KENNETH SQ
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3011
Practice Address - Country:US
Practice Address - Phone:410-433-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM01027172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist