Healthcare Provider Details

I. General information

NPI: 1326929258
Provider Name (Legal Business Name): JOHN CALDWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5819 BALSAM DR
HUDSONVILLE MI
49426-1104
US

IV. Provider business mailing address

3755 REMEMBRANCE RD NW STE 2
GRAND RAPIDS MI
49534-7745
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-5435
  • Fax:
Mailing address:
  • Phone: 616-608-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: