Healthcare Provider Details

I. General information

NPI: 1972688042
Provider Name (Legal Business Name): GINA R. COLLINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/04/2008
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 SUITE 20
SIMI VALLEY CA
93065-3972
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number27129
License Number StateCA

VIII. Authorized Official

Name: GINA R COLLINS
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: M.P.T.
Phone: 805-581-4266