Provider Demographics
NPI:1992889307
Name:GRIMSHAW, JOEL HAROLD (MPT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:HAROLD
Last Name:GRIMSHAW
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 EARL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-408-3515
Mailing Address - Fax:
Practice Address - Street 1:10924 US RT 11
Practice Address - Street 2:SUITE 7
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605
Practice Address - Country:US
Practice Address - Phone:315-232-2225
Practice Address - Fax:315-232-2800
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021628-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02441734Medicaid
NY02441734Medicaid