Provider Demographics
NPI:1568916070
Name:GRIMES, RONALD (PTA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:GRIMES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15431 PLANTATION OAKS DR
Mailing Address - Street 2:APT #9
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2129
Mailing Address - Country:US
Mailing Address - Phone:734-629-6674
Mailing Address - Fax:
Practice Address - Street 1:15431 PLANTATION OAKS DR
Practice Address - Street 2:APT #9
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2129
Practice Address - Country:US
Practice Address - Phone:734-629-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26492225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant