Healthcare Provider Details

I. General information

NPI: 1366528218
Provider Name (Legal Business Name): DIANE C COLLINS PT CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BAYLOR DR
BLUFFTON SC
29910-8965
US

IV. Provider business mailing address

333 E 34TH ST RM 1L
NEW YORK NY
10016-4956
US

V. Phone/Fax

Practice location:
  • Phone: 843-476-4682
  • Fax: 843-949-3022
Mailing address:
  • Phone: 212-689-2680
  • Fax: 212-689-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0074061
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11607
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: