Healthcare Provider Details

I. General information

NPI: 1407133994
Provider Name (Legal Business Name): BRADLEY LAWRENCE GROHOVSKY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 THOMPSON LN STE W
NASHVILLE TN
37211-2415
US

IV. Provider business mailing address

130 ADMIRAL COCHRANE DRIVE SUITE 101
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 615-270-9565
  • Fax: 888-508-2057
Mailing address:
  • Phone: 410-266-1500
  • Fax: 410-266-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number005944
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: