MEDICARE: KATHY GRIMSBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	16153	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16153	OTHER	CA	PT LICENSE

General Provider Information

NPI Number	:	1295898856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY GRIMSBY

Provider Business Mailing Address
First Line	:	9333 GENESEE AVE
Second Line	:	SUITE 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2111
Country	:	US
Telephone Number	:	858-453-3000
Fax Number	:	858-453-3066

Provider Business Practice Location Address
First Line	:	9333 GENESEE AVE
Second Line	:	SUITE 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2111
Country	:	US
Telephone Number	:	858-453-3000
Fax Number	:	858-453-3066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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Directions to “ KATHY GRIMSBY ” Practice Location

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