Healthcare Provider Details

I. General information

NPI: 1205188315
Provider Name (Legal Business Name): COLLIN L. HITTLE P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 W. CACTUS RD OAKESON PHYSICAL THERAPY
PEORIA AZ
85381
US

IV. Provider business mailing address

8240 W. CACTUS RD OAKESON PHYSICAL THERAPY
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 602-878-9696
  • Fax: 623-776-0668
Mailing address:
  • Phone: 623-878-9696
  • Fax: 623-776-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9386
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: