Provider Demographics
NPI:1669954244
Name:GRIMES, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 POND VIEW CIR NW
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44680-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 SMOKERISE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8702
Practice Address - Country:US
Practice Address - Phone:330-335-4200
Practice Address - Fax:330-335-7131
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
OHPTO21118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer