Healthcare Provider Details

I. General information

NPI: 1740109859
Provider Name (Legal Business Name): CAMERON CHARLES GRIMES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 SW MARKET ST
LEES SUMMIT MO
64081-2904
US

IV. Provider business mailing address

2423 N SPRING MEADOW ST
WICHITA KS
67205-1337
US

V. Phone/Fax

Practice location:
  • Phone: 816-607-7180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: