Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT2444 | MS |
N | 2251P0200X | Physical Therapist - Pediatrics | PT2444 | MS |
Y | 225CA2400X | Assistive Technology Practitioner | 74539 | MS |
NPI | 1255355947 |
---|---|
Provider Name | Mrs. Regina Lynn Grimes |
First Address | Houston, MS 38851-7642 |
Second Address | Houston, MS 38851-7642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 10/02/2020 |