Healthcare Provider Details

I. General information

NPI: 1790265239
Provider Name (Legal Business Name): MICHAEL GROESCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MAYFIELD RD
MAYFIELD HTS OH
44124-2270
US

IV. Provider business mailing address

27300 CEDAR RD
BEACHWOOD OH
44122-1110
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-4565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: