MEDICARE: MR. BRADLEY LAWRENCE GROHOVSKY DPT

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	2251X0800X	Orthopedic Physical Therapist	005944	KY

General Provider Information

NPI Number	:	1407133994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY LAWRENCE GROHOVSKY DPT

Provider Business Mailing Address
First Line	:	130 ADMIRAL COCHRANE DRIVE
Second Line	:	SUITE 101
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401
Country	:	US
Telephone Number	:	410-266-1500
Fax Number	:	410-266-1369

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	07/21/2022

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