Provider Demographics
NPI:1376664771
Name:BARCLAY, KEVIN D (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:BARCLAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7010
Mailing Address - Country:US
Mailing Address - Phone:517-990-6211
Mailing Address - Fax:517-990-6212
Practice Address - Street 1:2136 ROBINSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3557
Practice Address - Country:US
Practice Address - Phone:517-750-2540
Practice Address - Fax:517-750-2044
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C80788OtherBCBS
MIM9450004Medicare PIN