Provider Demographics
NPI:1225326622
Name:BARCALOW, KIMBERLY (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BARCALOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8680 GRATIOT RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-4885
Mailing Address - Country:US
Mailing Address - Phone:989-401-4791
Mailing Address - Fax:989-401-4794
Practice Address - Street 1:8680 GRATIOT RD STE B
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-4885
Practice Address - Country:US
Practice Address - Phone:989-401-4791
Practice Address - Fax:989-401-4794
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI550105646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015646OtherSTATE LICENSE
MI0N95180Medicare PIN