Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 13775 | NC |
Y | 2251X0800X | Physical Therapist - Orthopedic | 13775 | NC |
NPI | 1043566680 |
---|---|
Provider Name | Dr. Molly Elizabeth Grimm |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28277-4466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2012 |
Last Update Date | 31/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | NC |