MEDICARE: JOHN DAVID COLLANTES PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2188131	TX

General Provider Information

NPI Number	:	1013872852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID COLLANTES PTA

Provider Business Mailing Address
First Line	:	18081 MIDWAY RD APT 2627
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-6568
Country	:	US
Telephone Number	:	561-291-9608
Fax Number	:

Provider Business Practice Location Address
First Line	:	18081 MIDWAY RD APT 2627
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-6568
Country	:	US
Telephone Number	:	561-291-9608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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