Provider Demographics
NPI:1235806381
Name:GRIMES, CHRISTINE (BCTMB LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GRIMES
Suffix:
Gender:F
Credentials:BCTMB LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8706
Mailing Address - Country:US
Mailing Address - Phone:207-333-1140
Mailing Address - Fax:
Practice Address - Street 1:1146 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3739
Practice Address - Country:US
Practice Address - Phone:207-333-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty