Healthcare Provider Details

I. General information

NPI: 1285404871
Provider Name (Legal Business Name): JOHN ANDREW DROGE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 EDISON AVE NW
GRAND RAPIDS MI
49504-3918
US

IV. Provider business mailing address

4188 SAVANNAH CT SW
GRANDVILLE MI
49418-1741
US

V. Phone/Fax

Practice location:
  • Phone: 616-453-0993
  • Fax:
Mailing address:
  • Phone: 616-690-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502001221
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: