Provider Demographics
NPI:1043367071
Name:HARVEY, JAMES A (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:HARVEY
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 1:1650 BARLOW ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4721
Mailing Address - Country:US
Mailing Address - Phone:231-941-3100
Mailing Address - Fax:231-922-0382
Practice Address - Street 1:1650 BARLOW ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4721
Practice Address - Country:US
Practice Address - Phone:231-941-3100
Practice Address - Fax:231-922-0382
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650B810940OtherBLUE CROSS BLUE SHIELD
MI4597274Medicaid
MI0N83550001Medicare ID - Type Unspecified
MI4597274Medicaid