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General NPI Number Information
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NPI Number | 1366871915
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Entity Type | Individual
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Provider Name | TIMOTHY KEVIN DRUDGE ATC
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Gender | Male
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 14455 CLAY TERRACE BLVD SUITE A
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City | CARMEL
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State | IN
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Zip | 46032-3605
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Country | US
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Telephone | 317-415-5747
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Fax | 317-415-5748
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Provider Business Mailing Address
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Address Line | 3907 BRASSEUR LN
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City | CARMEL
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State | IN
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Zip | 46033-8419
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Country | US
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Telephone | 317-341-4871
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Fax | 317-415-5748
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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 | 36000399A
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License Number State | IN
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