Joel Harold Grimshaw, MPT
Individual provider Active NPI Physical Therapist · Adams, NY
NPI 1992889307 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992889307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 021628-1 (NY)
- Practice address
- 10924 US RT 11
Suite 7
Adams, NY 13605 - Phone
- (315) 232-2225
- Fax
- (315) 232-2800
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- East Coast Audiology and Physical Therapy PLLC
Practice addresses (Care Compare)
53 -59 Public SQ
Suite 202
Watertown, NY 13601-2674
Phone (315) 786-3225
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170308001722 | NY | Practitioner - Physical Therapist in Private Practice | 7719145549 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021628-1 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Coast Audiology and Physical Therapy, PLLC | Physical Therapist | Current |
Accepting new patients |
Locations
544 Towne Dr
Fayetteville, NY 13066
Phone (315) 637-8800
53-59 Public Sq
Ste 202
Watertown, NY 13601
Phone (315) 786-3225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 021628-1 | NY | Yes |
Addresses
Primary practice location
10924 US RT 11
Suite 7
Adams, NY 13605
Mailing address
814 Earl St
Watertown, NY 13601
Phone (315) 408-3515
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02441734 | Medicaid | NY |
Other providers in Adams, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.