Provider Demographics
NPI:1083087993
Name:GRIMSHAW, BIANCA (MS, ATC, OTC)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:GRIMSHAW
Suffix:
Gender:F
Credentials:MS, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1451
Mailing Address - Country:US
Mailing Address - Phone:502-637-7678
Mailing Address - Fax:502-588-7589
Practice Address - Street 1:215 CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1451
Practice Address - Country:US
Practice Address - Phone:502-637-7678
Practice Address - Fax:502-588-7589
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT13772255A2300X
19-0605246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer