MEDICARE: MEGAN 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	225700000X	Massage Therapist	19608	CA

General Provider Information

NPI Number	:	1588081269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN GRIMES

Provider Business Mailing Address
First Line	:	1095 STAFFORD WAY STE C
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3333
Country	:	US
Telephone Number	:	530-671-4616
Fax Number	:	530-671-6062

Provider Business Practice Location Address
First Line	:	1095 STAFFORD WAY STE C
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3333
Country	:	US
Telephone Number	:	530-671-4616
Fax Number	:	530-671-6062

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

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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Directions to “ MEGAN GRIMES ” Practice Location

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