1558557447 NPI number — JAMES R CREPS PT PC

Table of content: (NPI 1558557447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558557447 NPI number — JAMES R CREPS PT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES R CREPS PT PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JAMES CREPS PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558557447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 162
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLISSFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49228-0162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-486-5278
Provider Business Mailing Address Fax Number:
517-486-5298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S LANE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLISSFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49228-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-486-5278
Provider Business Practice Location Address Fax Number:
517-486-5298
Provider Enumeration Date:
09/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CREPS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-486-5278

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501002970 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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