Healthcare Provider Details

I. General information

NPI: 1215858824
Provider Name (Legal Business Name): DIANE COLLINS P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29200 SCHOOLCRAFT RD
LIVONIA MI
48150-2228
US

IV. Provider business mailing address

32601 CAMBRIDGE ST
GARDEN CITY MI
48135-1606
US

V. Phone/Fax

Practice location:
  • Phone: 734-523-1746
  • Fax: 734-325-1105
Mailing address:
  • Phone: 734-523-1746
  • Fax: 734-325-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502002189
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: