Healthcare Provider Details

I. General information

NPI: 1619230893
Provider Name (Legal Business Name): CHRISTINA LYNN MCCOLLOUGH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 BROADWAY AVE N
ROCHESTER MN
55906-4159
US

IV. Provider business mailing address

107 W 29TH ST SUITE 100
LOVELAND CO
80538-2797
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax:
Mailing address:
  • Phone: 970-663-6142
  • Fax: 970-635-3087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004208
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13851
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13324
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: