Healthcare Provider Details

I. General information

NPI: 1467019505
Provider Name (Legal Business Name): ELIZABETH GRIMSLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4337 WEBSTER AVE
CINCINNATI OH
45236-3639
US

IV. Provider business mailing address

4337 WEBSTER AVE
CINCINNATI OH
45236-3639
US

V. Phone/Fax

Practice location:
  • Phone: 513-328-8716
  • Fax:
Mailing address:
  • Phone: 513-328-8716
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number011450
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: