Healthcare Provider Details

I. General information

NPI: 1043789787
Provider Name (Legal Business Name): KATHRYN E COLLINS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 JUPITER AVE NE STE C
BELMONT MI
49306-8885
US

IV. Provider business mailing address

5060 CASCADE RD SE STE A
GRAND RAPIDS MI
49546-3808
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-3290
  • Fax: 616-364-3299
Mailing address:
  • Phone: 616-364-3290
  • Fax: 616-364-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018816
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: