Provider Demographics
NPI:1376504050
Name:GRUBB, TROY L (PT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:L
Last Name:GRUBB
Suffix:
Gender:M
Credentials:PT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 SHELBYVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1471
Mailing Address - Country:US
Mailing Address - Phone:502-244-9820
Mailing Address - Fax:502-244-9862
Practice Address - Street 1:12330 SHELBYVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1471
Practice Address - Country:US
Practice Address - Phone:502-244-9820
Practice Address - Fax:502-244-9862
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT 002841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5030402Medicare ID - Type Unspecified