Provider Demographics
NPI:1528767928
Name:GRIMSLEY, JAMES RAYMOND III (PTA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RAYMOND
Last Name:GRIMSLEY
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:KNOX CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79529-0362
Mailing Address - Country:US
Mailing Address - Phone:903-292-6834
Mailing Address - Fax:
Practice Address - Street 1:605 S AVENUE F
Practice Address - Street 2:
Practice Address - City:KNOX CITY
Practice Address - State:TX
Practice Address - Zip Code:79529-2103
Practice Address - Country:US
Practice Address - Phone:940-276-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2136193208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation