Provider Demographics
NPI:1760612832
Name:GRIMM, JULIE ANN (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8073 WASHINGTON VILLAGE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1847
Mailing Address - Country:US
Mailing Address - Phone:937-813-8052
Mailing Address - Fax:937-813-8056
Practice Address - Street 1:4090 GANTZ ROAD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123
Practice Address - Country:US
Practice Address - Phone:614-820-4992
Practice Address - Fax:614-820-4998
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT12505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH298360Medicare Oscar/Certification