Provider Demographics
NPI:1215192471
Name:GRIMES, KELLY R (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:R
Last Name:GRIMES
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 1:354 BARROWS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8423
Mailing Address - Country:US
Mailing Address - Phone:478-251-2812
Mailing Address - Fax:
Practice Address - Street 1:1203 N COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2395
Practice Address - Country:US
Practice Address - Phone:478-452-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist