Mr. Ivan Broaderick Gresham
Mr. Ivan Broaderick Gresham is a Physical Therapy Assistant in Callahan, Florida. Licensed in Florida. Registered with an NPI since 2013.
- Licensed in
- FL
- In the registry since
- 2013
Practice location Address checks out
45390 Green AveCallahan, FL 32011-3711
Phone: (904) 879-1223
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Physical Therapy Assistant (primary) | Taxonomy 225200000X · Licence PTA24242 (FL) |
|---|
Record details
| NPI number | 1457789653 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | October 24, 2013 |
| Last updated in NPPES | October 24, 2013 |
| Mailing address | 45390 Green Ave, Callahan, FL 32011-3711 |
Other providers in Callahan
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Mr. Jerry Lynn Edwards, PTA
45390 Green Ave, Callahan, FL 32011-3711 · (904) 879-1223
-
Jordan Powell, PTA
45390 Green Ave, Callahan, FL 32011-3711 · (904) 879-1223