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NPI Code Detail

MEDICARE: NICHOLAS GRIMOSKAS PT

MEDICARE: NICHOLAS GRIMOSKAS PT
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
1225100000XPhysical Therapist076593IA

General Provider Information

NPI Number : 1578939690
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS GRIMOSKAS PT
Provider Business Mailing Address
First Line : 850 43RD AVE STE 100
Second Line :
City : MOLINE
State : IL
Zip : 61265-8401
Country : US
Telephone Number : 309-743-2070
Fax Number : 309-743-2073
Provider Business Practice Location Address
First Line : 609 SOUTH EAST KEND
Second Line :
City : GREENFIELD
State : IA
Zip : 50849-9454
Country : US
Telephone Number : 641-743-2123
Fax Number : 641-743-7283
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2015
Last Update Date : 08/12/2015

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Directions to “ NICHOLAS GRIMOSKAS PT” Practice Location

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