Provider Demographics
NPI:1861669350
Name:GRIMSLEY, KENA A (PT)
Entity Type:Individual
Prefix:
First Name:KENA
Middle Name:A
Last Name:GRIMSLEY
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 1:110 LAKE POINT DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-5218
Mailing Address - Country:US
Mailing Address - Phone:919-989-6594
Mailing Address - Fax:919-989-6532
Practice Address - Street 1:138 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4758
Practice Address - Country:US
Practice Address - Phone:919-989-6594
Practice Address - Fax:919-989-6532
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist