Provider Demographics
NPI:1174191407
Name:GRIMALT, EUGENIA N (PT)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:N
Last Name:GRIMALT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6396 SW MCVEY AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9069
Mailing Address - Country:US
Mailing Address - Phone:541-389-1848
Mailing Address - Fax:
Practice Address - Street 1:6396 SW MCVEY AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9069
Practice Address - Country:US
Practice Address - Phone:541-389-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR639792251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty