Healthcare Provider Details

I. General information

NPI: 1639424377
Provider Name (Legal Business Name): PRESTON COLLINS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W STANFORD AVE
GILBERT AZ
85233-2622
US

IV. Provider business mailing address

695 W STANFORD AVE
GILBERT AZ
85233-2622
US

V. Phone/Fax

Practice location:
  • Phone: 480-766-1033
  • Fax:
Mailing address:
  • Phone: 480-766-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-011010
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberLPT-011010
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: