Provider Demographics
NPI:1225126782
Name:CREPS, JAMES R (PT, DSCPT, OCS, CMPT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CREPS
Suffix:
Gender:M
Credentials:PT, DSCPT, OCS, CMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S LANE ST
Mailing Address - Street 2:PO BOX 162
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-1243
Mailing Address - Country:US
Mailing Address - Phone:517-486-5278
Mailing Address - Fax:517-486-5298
Practice Address - Street 1:202 S LANE ST
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-1243
Practice Address - Country:US
Practice Address - Phone:517-486-5278
Practice Address - Fax:517-486-5298
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5387590001OtherMEDICARE DME ID
MI650D610700OtherBCBS OF MICHIGAN INDIV ID
MI0007902726OtherAETNA PROVIDER ID
MI104795708Medicaid
MI151452OtherGLHP INDIV ID
MI141688OtherPREFERRED CHOICES INDIVID
MI853320223OtherUNITED HEALTHCARE INDIVID
MI141688OtherCARE CHOICES INDIV ID
MI9185183OtherCIGNA PPO INDIV ID
MI104795708Medicaid