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Individual
MR. MATTHEW WILLIAM GRIMM
Active
Individual
MR. MATTHEW WILLIAM GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501012853
MI
225100000X
Physical Therapist
Primary
P14088
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255359287
NPI
MI
01
—
650D116650
BCBS
MI
05
—
PENDING
—
NC
Enumeration date
07/17/2006
Last updated
11/05/2015
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