Provider Demographics
NPI:1225151913
Name:GRIMES, ERIKA SELGA (ATC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:SELGA
Last Name:GRIMES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690424
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-0424
Mailing Address - Country:US
Mailing Address - Phone:321-217-7857
Mailing Address - Fax:
Practice Address - Street 1:262 PARADISE ISLAND DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844
Practice Address - Country:US
Practice Address - Phone:321-217-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer