Provider Demographics
NPI:1962994780
Name:GRIMM, NANCY (PTA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 N MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2710
Mailing Address - Country:US
Mailing Address - Phone:414-562-4386
Mailing Address - Fax:414-562-4397
Practice Address - Street 1:2578 N MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2710
Practice Address - Country:US
Practice Address - Phone:414-562-4386
Practice Address - Fax:414-562-4397
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant