Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 FALCON CREST DR STE 301
REDMOND OR
97756-5022
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 541-527-4353
  • Fax:
Mailing address:
  • Phone: 423-238-8995
  • Fax:

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 NumberCP061418T
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60017
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: