MEDICARE: DARYIAN MICHELLE GROSSMAN 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	225100000X	Physical Therapist	2509	ND

General Provider Information

NPI Number	:	1508597634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYIAN MICHELLE GROSSMAN DPT

Provider Business Mailing Address
First Line	:	400 E 9TH ST
Second Line	:
City	:	TRENTON
State	:	MO
Zip	:	64683-2207
Country	:	US
Telephone Number	:	660-654-2892
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E 9TH ST
Second Line	:
City	:	TRENTON
State	:	MO
Zip	:	64683-2207
Country	:	US
Telephone Number	:	660-654-2892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	04/22/2026

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