Provider Demographics
NPI:1285644435
Name:BARNES, MICHAEL STEVEN (PT, MPT, OCS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:BARNES
Suffix:
Gender:M
Credentials:PT, MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5622
Practice Address - Country:US
Practice Address - Phone:864-999-4626
Practice Address - Fax:864-794-5434
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0150252251X0800X
SC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86067TOtherBLUE CROSS BLUE SHIELD
TX83633EMedicare ID - Type Unspecified
TX86067TOtherBLUE CROSS BLUE SHIELD