Provider Demographics
NPI:1962582486
Name:GRIME, RENEE J (PT, ACT/L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:J
Last Name:GRIME
Suffix:
Gender:F
Credentials:PT, ACT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:2500 W STRUB RD STE 150
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5488
Practice Address - Country:US
Practice Address - Phone:419-626-4162
Practice Address - Fax:419-626-2071
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT11044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4156221Medicare ID - Type Unspecified