Provider Demographics
NPI:1457919953
Name:GRIMES, BROOKE MCKINSEY (PT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MCKINSEY
Last Name:GRIMES
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:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0246
Mailing Address - Country:US
Mailing Address - Phone:270-597-2100
Mailing Address - Fax:
Practice Address - Street 1:520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9037
Practice Address - Country:US
Practice Address - Phone:270-597-2100
Practice Address - Fax:888-244-5043
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP2019041225100000X
KY007741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist