Provider Demographics
NPI:1740016286
Name:GRIM, WESTON
Entity type:Individual
Prefix:
First Name:WESTON
Middle Name:
Last Name:GRIM
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 1:3 UPPER BANK DR
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9731
Mailing Address - Country:US
Mailing Address - Phone:267-290-8759
Mailing Address - Fax:
Practice Address - Street 1:3 UPPER BANK DR
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9731
Practice Address - Country:US
Practice Address - Phone:267-290-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer