Healthcare Provider Details

I. General information

NPI: 1609856756
Provider Name (Legal Business Name): SHAWN CHRISTOPHER GRIMES MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 NW MILLER AVE
GRESHAM OR
97030-7260
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD
TIGARD OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-7644
  • Fax: 503-674-9980
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8118
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60017
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: