Provider Demographics
NPI:1891127064
Name:GRIMM, LYNN (PT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GRIMM
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 1:12565 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3222
Mailing Address - Country:US
Mailing Address - Phone:504-228-0524
Mailing Address - Fax:
Practice Address - Street 1:1510 WOODLAND HWY
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1639
Practice Address - Country:US
Practice Address - Phone:504-228-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00686225100000X
LA00686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist