Healthcare Provider Details

I. General information

NPI: 1174608343
Provider Name (Legal Business Name): LUV COLLINS P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E LOS ANGELES AVE SUITE 20
SIMI VALLEY CA
93065-3972
US

IV. Provider business mailing address

3200 E LOS ANGELES AVE STE 20
SIMI VALLEY CA
93065-3971
US

V. Phone/Fax

Practice location:
  • Phone: 805-581-4266
  • Fax: 805-581-5049
Mailing address:
  • Phone: 805-581-4266
  • Fax: 805-581-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT4880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: