Provider Demographics
NPI:1225174345
Name:GRIMSBY, OLA JR (PT, MOMT, FAAOMPT)
Entity Type:Individual
Prefix:MR
First Name:OLA
Middle Name:
Last Name:GRIMSBY
Suffix:JR
Gender:M
Credentials:PT, MOMT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 140TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4516
Mailing Address - Country:US
Mailing Address - Phone:425-644-6048
Mailing Address - Fax:425-641-2721
Practice Address - Street 1:1540 140TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4516
Practice Address - Country:US
Practice Address - Phone:425-644-6048
Practice Address - Fax:425-641-2721
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist