MEDICARE: IPA PHYSIO NASHVILLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT0000010633	TN

General Provider Information

NPI Number	:	1265951503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IPA PHYSIO NASHVILLE LLC

Provider Business Mailing Address
First Line	:	197 THOMPSON LN STE W
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-2415
Country	:	US
Telephone Number	:	615-270-9565
Fax Number	:	888-508-2057

Provider Business Practice Location Address
First Line	:	197 THOMPSON LN STE W
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-2415
Country	:	US
Telephone Number	:	615-270-9565
Fax Number	:	888-508-2057

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRADLEY LAWRENCE GROHOVSKY
Credential	:	DPT, CFMT
Telephone Number	:	615-270-9565

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	07/21/2022

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