MEDICARE: MARY EILEEN GRIMES

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	225200000X	Physical Therapy Assistant	160007467	IL

General Provider Information

NPI Number	:	1477301448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY EILEEN GRIMES

Provider Business Mailing Address
First Line	:	2320 W 113TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4117
Country	:	US
Telephone Number	:	773-474-7386
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 W 113TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4117
Country	:	US
Telephone Number	:	773-474-7386
Fax Number	:

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

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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Directions to “ MARY EILEEN GRIMES ” Practice Location

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