Healthcare Provider Details

I. General information

NPI: 1780432179
Provider Name (Legal Business Name): COLLIN DEBARBRIE DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD STE 109
GILBERT AZ
85297-8510
US

IV. Provider business mailing address

126 E COUNTY ROAD 16
TIFFIN OH
44883-8932
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-3151
  • Fax:
Mailing address:
  • Phone: 567-230-3892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033564
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: