Provider Demographics
NPI:1952641292
Name:GRIMM, SARAH MICHELLE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MICHELLE
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 NESMITH ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-4696
Mailing Address - Country:US
Mailing Address - Phone:813-523-9551
Mailing Address - Fax:
Practice Address - Street 1:2809 NESMITH ESTATES LN
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-4696
Practice Address - Country:US
Practice Address - Phone:813-523-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 22791225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant