Healthcare Provider Details

I. General information

NPI: 1417194655
Provider Name (Legal Business Name): LAUREN HALLIE COLLINS DPT, PWCS, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12164 CENTRAL AVE STE 212
BOWIE MD
20721-1902
US

IV. Provider business mailing address

4656 A ST SE
WASHINGTON DC
20019-8431
US

V. Phone/Fax

Practice location:
  • Phone: 240-929-4257
  • Fax:
Mailing address:
  • Phone: 313-550-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009596
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number036196-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24460
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP062911T
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: