=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871789313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA L GRIMM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 09/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 MARY ST
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15203-2054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-488-5671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 KAREN PL
-----------------------------------------------------
City | MUNHALL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15120-3614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT018963
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------