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General NPI Number Information
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NPI Number | 1447304639
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Entity Type | Individual
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Provider Name | JENNIFER CHRISTY-GRIMM P.T.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3555 PARK PL W STE 200
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City | MISHAWAKA
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State | IN
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Zip | 46545-3587
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Country | US
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Telephone | 574-271-8646
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Fax | 574-271-8624
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Provider Business Mailing Address
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Address Line | 3555 PARK PL W STE 200
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City | MISHAWAKA
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State | IN
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Zip | 46545-3587
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Country | US
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Telephone | 574-271-8646
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Fax | 574-271-8624
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05007232A
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License Number State | IN
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