Healthcare Provider Details

I. General information

NPI: 1962277533
Provider Name (Legal Business Name): JOHN ANTHONY GROSSI PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2023
Last Update Date: 11/23/2023
Certification Date: 11/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 ASHLEY MARIA CT
CRESTVIEW FL
32539-6381
US

IV. Provider business mailing address

2706 ASHLEY MARIA CT
CRESTVIEW FL
32539-6381
US

V. Phone/Fax

Practice location:
  • Phone: 850-217-6589
  • Fax:
Mailing address:
  • Phone: 850-217-6589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT16693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: