Healthcare Provider Details

I. General information

NPI: 1861755183
Provider Name (Legal Business Name): HELEN GRIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N C ST
ROGERS AR
72756-2915
US

IV. Provider business mailing address

621 N C ST
ROGERS AR
72756-2915
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5615
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1217529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: