MEDICARE: HILLARY SAMPSON GRIMM MSPT

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	1155030	TX

General Provider Information

NPI Number	:	1386687887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILLARY SAMPSON GRIMM MSPT

Provider Business Mailing Address
First Line	:	4031 W PLANO PKWY
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75093-5619
Country	:	US
Telephone Number	:	972-596-1715
Fax Number	:	972-867-9726

Provider Business Practice Location Address
First Line	:	4031 W PLANO PKWY
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75093-5619
Country	:	US
Telephone Number	:	972-596-1715
Fax Number	:	972-867-9726

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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