Provider Demographics
NPI:1710291059
Name:STEIN GRIMSHAW, SUSAN M (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:STEIN GRIMSHAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 RIO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MO
Mailing Address - Zip Code:65656-7140
Mailing Address - Country:US
Mailing Address - Phone:417-357-0411
Mailing Address - Fax:
Practice Address - Street 1:791 RIO VISTA DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MO
Practice Address - Zip Code:65656-7140
Practice Address - Country:US
Practice Address - Phone:417-357-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200803597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist