Healthcare Provider Details

I. General information

NPI: 1205750627
Provider Name (Legal Business Name): BRANDON GRIMSLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10095 SCRIPPS RANCH CT
SAN DIEGO CA
92131-1200
US

IV. Provider business mailing address

10095 SCRIPPS RANCH CT
SAN DIEGO CA
92131-1200
US

V. Phone/Fax

Practice location:
  • Phone: 858-324-5537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: