Individual provider · Type 1 NPI

Ivan Broaderick Gresham

Physical Therapy Assistant · Callahan, FL

NPI number 1457789653 Active

Practice location

45390 Green Ave
Callahan, FL 32011-3711

Specialties and licenses

TaxonomyCodeLicense
Physical Therapy Assistant Primary 225200000XPTA24242 (FL)

Physical Therapy Assistant: (1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Postsecondary Accreditation, who assists the physical therapist in providing physical therapy. The supervising physical therapist is directly responsible for the actions of …

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About NPI 1457789653

Ivan Broaderick Gresham's National Provider Identifier is 1457789653, issued on Oct 24, 2013. The primary taxonomy on file is Physical Therapy Assistant (225200000X), and the practice location is in Callahan, FL. The record was last updated on Oct 24, 2013.