Individual provider Active NPI

Bradley Grgurich, DPT

  • Physical Therapist
  • Draper, UT
National Provider Identifier
1235497918
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT029354 Issued in PA
Practice address
65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096
Phone
(385) 308-8034
NPI assigned
May 1, 2012
Last updated
Jun 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11-06940 KS
Physical Therapist 225100000X P20917 NC
Physical Therapist 225100000X 11080 CO
Physical Therapist 225100000X 10798 SC
Physical Therapist 225100000X PT029354 PA Primary
Physical Therapist 225100000X 048542 NY
Physical Therapist 225100000X 301264 CA
Physical Therapist 225100000X 040.0134367 VT
Physical Therapist 225100000X PT-2026-0161 NM
Physical Therapist 225100000X 13331 CT

Addresses

Primary practice location

65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096

Mailing address

65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096
Phone (385) 308-8034

Other practice location 1

65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096
Phone (385) 308-8034

Other practice location 2

805 N Richardson Ave
Roswell, NM 88201-4920
Phone (575) 622-6260

Other identifiers 1

IdentifierTypeStateIssuer
11080OtherCOLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250227002239 GA Practitioner - Physical Therapist in Private Practice 8527224955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6298 Veterans Pkwy
Suite 5a
Columbus, GA 31909-6245
Phone (706) 320-0927

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10798SCMDInternal Medicine Physician
301264CAMDPhysical Therapist
11080COMDPhysical Therapist
11-06940KSMDPhysical Therapist
P20917NCMDPhysical Therapist
PT-2026-0161NMMDPhysical Therapist
048542NYMDPhysical Therapist
040.0134367VTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Human Performance and Rehabilitation Centers, LLC Multi-Specialty CurrentSince Oct 16, 2024 Accepting new patients
Sentry Home Health Care LLC Physical Therapist CurrentSince Jun 3, 2026 Accepting new patients
Sentry Safety and Physical Therapy Specialists, LLC Multi-Specialty CurrentSince Jun 3, 2026 Accepting new patients
Human Performance and Rehabilitation Centers LLC CurrentSince Oct 16, 2024 Accepting new patients

Locations

6298 Veterans Pkwy
Ste 5A
Columbus, GA 31909
Phone (706) 320-0927

1650 Lyndon Farm Ct
Ste 300
Louisville, KY 40223
Phone (726) 202-3039

805 N Richardson Ave
Roswell, NM 88201
Phone (575) 622-6260

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1235497918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 E WADSWORTH PARK DR STE 230",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840208096",
            "telephone_number": "385-308-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 E WADSWORTH PARK DR STE 230",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840208096",
            "telephone_number": "385-308-8034"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "65 E Wadsworth Park Dr Ste 230",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840208096",
            "country_code": "US",
            "telephone_number": "385-308-8034",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "805 N Richardson Ave",
            "address_purpose": "LOCATION",
            "city": "Roswell",
            "state": "NM",
            "postal_code": "882014920",
            "country_code": "US",
            "telephone_number": "575-622-6260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRGURICH",
        "first_name": "BRADLEY",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-01",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-06940",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P20917",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "11080",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "10798",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT029354",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "048542",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "301264",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040.0134367",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "PT-2026-0161",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "13331",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "11080",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.