Provider Demographics
NPI:1578848438
Name:GRIMM, MARY (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8100 SANDPIPER CIR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4991
Mailing Address - Country:US
Mailing Address - Phone:410-933-3737
Mailing Address - Fax:410-933-3747
Practice Address - Street 1:8100 SANDPIPER CIR
Practice Address - Street 2:SUITE 106
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4991
Practice Address - Country:US
Practice Address - Phone:410-933-3737
Practice Address - Fax:410-933-3747
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305207049225100000X
MD23713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist