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General NPI Number Information
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NPI Number | 1326936410
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Entity Type | Individual
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Provider Name | ROBERT GOERGE ATC
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1079 S US HIGHWAY 27
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City | SAINT JOHNS
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State | MI
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Zip | 48879-2437
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Country | US
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Telephone | 989-640-6640
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 SANDY LN
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City | SAINT JOHNS
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State | MI
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Zip | 48879-1109
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Country | US
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Telephone | 989-640-6640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000058418
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License Number State | MI
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