Nathaniel Vincent Grimm, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126003499 Issued in VA

Practice address

19401 Crystal Rock Dr
Germantown, MD 20874-1593

Phone

(585) 645-8640

NPI assigned

Nov 6, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657324800000",
    "number": "1841955671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 DUNWOODY XING",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145809449",
            "telephone_number": "585-645-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19401 CRYSTAL ROCK DR",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208741593",
            "telephone_number": "585-645-8640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14800 Darbydale Ave",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221932763",
            "country_code": "US",
            "telephone_number": "703-670-6166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIMM",
        "first_name": "NATHANIEL",
        "middle_name": "VINCENT",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-06",
        "last_updated": "2022-07-09",
        "certification_date": "2022-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126003499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean M Greenhood, PT
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• Shari K Griffen, DNP
• Martha Grim
• Virginia Groves, MD
• Teresa Guerra, DPT
• Ashwin Gujar
• Roopa Gulati-Rao, MS, DDS
• David Guzman

• Athletic Trainer in Germantown, MD
• Providers in Germantown, MD by specialty
• Athletic Trainer in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.