ORTHOPAEDIC REHAB SPECIALISTS, PC

Provider Demographics

• NPI: 1619956646
• Name: ORTHOPAEDIC REHAB SPECIALISTS, PC
• Entity Type: Organization
• Organization Name: ORTHOPAEDIC REHAB SPECIALISTS, PC
• Authorized Official - Title/Position: CEO, CO-OWNER, PT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: KEVIN
• Authorized Official - Last Name: BARCLAY
• Authorized Official - Credentials: PT
• Authorized Official - Phone: 517-783-6670
• Mailing Address - Street 1: 113 S EAST AVE
• Mailing Address - City: JACKSON
• Mailing Address - State: MI
• Mailing Address - Zip Code: 49201-2411
• Mailing Address - Country: US
• Mailing Address - Phone: 517-990-6211
• Mailing Address - Fax: 517-990-6212
• Practice Address - Street 1: 214 N WEST AVE STE B
• Practice Address - City: JACKSON
• Practice Address - State: MI
• Practice Address - Zip Code: 49201-1903
• Practice Address - Country: US
• Practice Address - Phone: 517-783-6670
• Practice Address - Fax: 517-783-5310
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-01-10
• Last Update Date: 2023-04-10

Provider Licenses

State	License ID	Taxonomies
		225100000X, 225X00000X, 235Z00000X
MI	JM002302	225100000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	650C810770	Other	BCBS BRANDON KLUMP, PT
MI	650C857070	Other	BCBS LISA MCCARRELL, PT
MI	650C857110	Other	BCBS DAVID POLSON, PT
MI	650C811590	Other	BCBS EMILY KLUMP, PTD
MI	650C857090	Other	BCBS KEVIN D. BARCLAY, PT
MI	650C857030	Other	BCBS RICHARD A KOHLER
MI	650C857040	Other	BCBS JEROME MALONE, PT
MI	650C857140	Other	BCBS AARON HOLLY, PT
MI	650C857090	Other	BCBS KEVIN D. BARCLAY, PT
	OM94500	Medicare UPIN
MI	0M94500010	Medicare ID - Type Unspecified	MEDICARE EMILY E. MILLER
MI	650C857040	Other	BCBS JEROME MALONE, PT
MI	0M94500005	Medicare ID - Type Unspecified	DAVID L. POLSON, PT
MI	0M94500004	Medicare ID - Type Unspecified	KEVIN D. BARCLAY, PT
MI	0M94500	Medicare PIN
MI	650C857070	Other	BCBS LISA MCCARRELL, PT
MI	0M94500006	Medicare ID - Type Unspecified	LISA A. MCCARRELL, PT
MI	650C811590	Other	BCBS EMILY KLUMP, PTD
MI	0M94500001	Medicare ID - Type Unspecified	RICHARD A. KOHLER, PT
MI	M94500013	Medicare PIN