Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Samuel Nissly

Individual provider Physical Therapist · NPI 1700620051

Samuel Nissly is a Physical Therapist in Private Practice in Grimes, Iowa. Qualified in 2024, 2 years ago. Practices with Athletico Ltd, a 2,186-clinician group and accepts Medicare assignment. Licensed in Iowa.

Years since qualifying
2
Licensed in
IA
In the registry since
2024

Practice location Address checks out

241 SE Destination Dr Ste 200
Grimes, IA 50111-1249
Phone: (515) 986-5190
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 126470 (IA)

Record details

NPI number1700620051
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 21, 2024
Last updated in NPPESJune 21, 2024
Certification dateJune 21, 2024
Mailing addressPo Box 321, Dallas Center, IA 50063-0321

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Grimes