Provider Demographics
NPI:1821090465
Name:DREW, ROBERT WILLIAM (MSPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:DREW
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71602
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-0602
Mailing Address - Country:US
Mailing Address - Phone:515-243-2057
Mailing Address - Fax:515-244-5570
Practice Address - Street 1:408 CAMPUS DRIVE SUITE B
Practice Address - Street 2:
Practice Address - City:HUXLEY
Practice Address - State:IA
Practice Address - Zip Code:50124-0298
Practice Address - Country:US
Practice Address - Phone:515-597-3729
Practice Address - Fax:515-597-3727
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0240366Medicaid
IAI3316001Medicare PIN
P35591Medicare UPIN