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General NPI Number Information
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NPI Number | 1609751122
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Entity Type | Organization
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Legal Business Name | GROW PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 512 W PHILLIP AVE
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City | NORFOLK
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State | NE
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Zip | 68701-5208
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Country | US
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Telephone | 402-644-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 W NORFOLK AVE
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City | NORFOLK
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State | NE
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Zip | 68701-4427
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Country | US
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Telephone | 402-370-8084
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JESSIE KORTH
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Credential | PT, DPT
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Telephone | 402-370-8084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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