Healthcare Provider Details

I. General information

NPI: 1588599302
Provider Name (Legal Business Name): JAYCEE GRIMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 S 42ND ST STE 106
BELLEVUE NE
68123-1089
US

IV. Provider business mailing address

11511 S 42ND ST STE 106
BELLEVUE NE
68123-1089
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-4678
  • Fax: 402-933-9137
Mailing address:
  • Phone: 402-502-4678
  • Fax: 402-933-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4960
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: