Provider Demographics
NPI:1306065172
Name:GRIMES, TRISCH VICTORIA (MPT)
Entity type:Individual
Prefix:MISS
First Name:TRISCH
Middle Name:VICTORIA
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PACKER AVE
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-2907
Mailing Address - Country:US
Mailing Address - Phone:334-222-7283
Mailing Address - Fax:
Practice Address - Street 1:600 PACKER AVE
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-2907
Practice Address - Country:US
Practice Address - Phone:334-222-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist