Provider Demographics
NPI:1649885328
Name:GRIMALDO, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GRIMALDO
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 1:9326 MARBLEMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-2221
Mailing Address - Country:US
Mailing Address - Phone:281-610-3143
Mailing Address - Fax:
Practice Address - Street 1:9380 W SAM HOUSTON PKWY S STE 80
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5222
Practice Address - Country:US
Practice Address - Phone:832-300-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1336431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist