Healthcare Provider Details

I. General information

NPI: 1124956933
Provider Name (Legal Business Name): JOSHUA IDRIS COLLIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 ALLIUM CT
SPRINGFIELD OH
45505-1664
US

IV. Provider business mailing address

4401 STRATHAVEN DR
DAYTON OH
45424-4656
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-7671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA09544
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: