Healthcare Provider Details

I. General information

NPI: 1174191407
Provider Name (Legal Business Name): EUGENIA N GRIMALT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 NE 3RD ST STE 7
BEND OR
97701-4278
US

IV. Provider business mailing address

1404 NE 3RD ST STE 7
BEND OR
97701-4278
US

V. Phone/Fax

Practice location:
  • Phone: 541-410-2962
  • Fax:
Mailing address:
  • Phone: 541-410-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number63979
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: