Healthcare Provider Details

I. General information

NPI: 1356555841
Provider Name (Legal Business Name): AMY M COLLINS M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 COOK AVE
LAKEWOOD OH
44107-2565
US

IV. Provider business mailing address

1356 COOK AVE
LAKEWOOD OH
44107-2565
US

V. Phone/Fax

Practice location:
  • Phone: 216-739-1930
  • Fax: 216-739-9668
Mailing address:
  • Phone: 216-739-1930
  • Fax: 216-739-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number10000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: