Healthcare Provider Details

I. General information

NPI: 1205047966
Provider Name (Legal Business Name): KARLA GRIMMETT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E ASH ST
HERINGTON KS
67449-1662
US

IV. Provider business mailing address

1577 S 500 RD
COUNCIL GROVE KS
66846-8382
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-6400
  • Fax:
Mailing address:
  • Phone: 620-767-5846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-00129
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: