Healthcare Provider Details

I. General information

NPI: 1316910052
Provider Name (Legal Business Name): DANA MARTIN COLLINS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 VILLAGE SQUARE DR
PADUCAH KY
42001-9060
US

IV. Provider business mailing address

180 KATHERINE WAY
PADUCAH KY
42001-9541
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0681
  • Fax:
Mailing address:
  • Phone: 270-443-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: