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NPI Code Detail

MEDICARE: MR. JESSE COY GRIMMETT

MEDICARE: MR. JESSE COY GRIMMETT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist29412OR

General Provider Information

NPI Number : 1255272951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JESSE COY GRIMMETT
Provider Business Mailing Address
First Line : 4263 SE BELMONT ST APT B
Second Line :
City : PORTLAND
State : OR
Zip : 97215-1661
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4230 NE FREMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97213-1150
Country : US
Telephone Number : 503-208-5532
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “ MR. JESSE COY GRIMMETT ” Practice Location

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