MEDICARE: SUSAN M STEIN GRIMSHAW P.T.

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	200803597	MO

General Provider Information

NPI Number	:	1710291059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M STEIN GRIMSHAW P.T.

Provider Business Mailing Address
First Line	:	791 RIO VISTA DR
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-7140
Country	:	US
Telephone Number	:	417-357-0411
Fax Number	:

Provider Business Practice Location Address
First Line	:	791 RIO VISTA DR
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-7140
Country	:	US
Telephone Number	:	417-357-0411
Fax Number	:

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

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	12/10/2013

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