Provider Demographics
NPI:1669613923
Name:GRIMM, REBEKAH (PT, DPT)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:ORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:327 GUNDERSEN DR
Practice Address - Street 2:SUITE C
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2402
Practice Address - Country:US
Practice Address - Phone:630-784-3251
Practice Address - Fax:630-665-8188
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00859995OtherMEDICARE RR
ILP00859995OtherMEDICARE RR