Provider Demographics
NPI:1922513043
Name:GRIMLEY, BRYAN (ATC, VATL)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:GRIMLEY
Suffix:
Gender:M
Credentials:ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COL EDMONDS CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2179
Mailing Address - Country:US
Mailing Address - Phone:540-270-2710
Mailing Address - Fax:
Practice Address - Street 1:705 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3038
Practice Address - Country:US
Practice Address - Phone:540-422-7300
Practice Address - Fax:540-422-7325
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer