Provider Demographics
NPI:1396119228
Name:KROMBEEN, DAVID CLARK (DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CLARK
Last Name:KROMBEEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 LAKE DR SE
Mailing Address - Street 2:STE 105
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1674
Mailing Address - Country:US
Mailing Address - Phone:616-534-0366
Mailing Address - Fax:616-534-0540
Practice Address - Street 1:4120 CHICAGO DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1281
Practice Address - Country:US
Practice Address - Phone:616-534-0366
Practice Address - Fax:616-534-0540
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist