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Mr. Ivan Broaderick Gresham

Physical Therapy Assistant in Callahan, FL · enumerated 2013 · practices at Nassau Physical Therapy Inc.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1457789653

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Registry record

Entity type Individual (Type 1)
Name Mr. Ivan Broaderick Gresham
Sex Male
Practice address 45390 Green Ave, Callahan, FL, 32011
Phone (904) 879-1223
Enumeration date Oct 24, 2013
Last updated in NPPES Oct 24, 2013

Taxonomy & licenses

225200000X Physical Therapy Assistant Respiratory, Developmental, Rehabilitative and Restorative Service Providers · License PTA24242 (FL) Primary

Other identifiers

Identifier Type State Issuer
PTA24242 Other FL STATE LICENSE #

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Is this the official NPI registry?
No. NPI Portal is a private site built on public CMS NPPES data. The official registry is npiregistry.cms.hhs.gov, operated by CMS.
What specialty is Ivan Gresham?
Ivan Gresham is registered in NPPES with the primary taxonomy of Physical Therapy Assistant. The taxonomy code describes the provider's classification and area of specialization for claims and credentialing.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2013-10-24.