Provider Demographics
NPI:1588899728
Name:JOHNSON, DREW ELIZABETH (ATC)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 20 MILE RD
Mailing Address - Street 2:P.O. BOX 54
Mailing Address - City:KENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49330-9492
Mailing Address - Country:US
Mailing Address - Phone:616-262-2028
Mailing Address - Fax:
Practice Address - Street 1:400 E BROWN ST
Practice Address - Street 2:APARTMENT 811
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7807
Practice Address - Country:US
Practice Address - Phone:616-262-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0045402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer