Provider Demographics
NPI:1972756559
Name:GRIM, JANICE R (PT)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:R
Last Name:GRIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1846
Mailing Address - Country:US
Mailing Address - Phone:330-759-2603
Mailing Address - Fax:330-759-2569
Practice Address - Street 1:3000 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1846
Practice Address - Country:US
Practice Address - Phone:330-759-2603
Practice Address - Fax:330-759-2569
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT006023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist