Healthcare Provider Details

I. General information

NPI: 1184930240
Provider Name (Legal Business Name): KRISTIN LYNN COLLINS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N 200 E
COLUMBIA CITY IN
46725-8895
US

IV. Provider business mailing address

169 N 200 E
COLUMBIA CITY IN
46725-8895
US

V. Phone/Fax

Practice location:
  • Phone: 260-244-5133
  • Fax: 260-244-5134
Mailing address:
  • Phone: 260-244-5133
  • Fax: 260-244-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010374A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: