Provider Demographics
NPI:1366871915
Name:DRUDGE, TIMOTHY KEVIN (ATC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:KEVIN
Last Name:DRUDGE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3907 BRASSEUR LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8419
Mailing Address - Country:US
Mailing Address - Phone:317-341-4871
Mailing Address - Fax:317-415-5748
Practice Address - Street 1:14455 CLAY TERRACE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3605
Practice Address - Country:US
Practice Address - Phone:317-415-5747
Practice Address - Fax:317-415-5748
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000399A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer