Provider Demographics
NPI:1972748473
Name:GRIMES, CHRISTY A (MS ED, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:A
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MS ED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7628 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1736
Mailing Address - Country:US
Mailing Address - Phone:816-444-5055
Mailing Address - Fax:
Practice Address - Street 1:8700 NW RIVER PARK DR # 1053
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-4358
Practice Address - Country:US
Practice Address - Phone:816-584-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060368722255A2300X
KS24002612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer