Healthcare Provider Details

I. General information

NPI: 1033387220
Provider Name (Legal Business Name): DEMETRIUS RAY COLLINS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BEECAVE WOODS DR STE 102
AUSTIN TX
78746-6752
US

IV. Provider business mailing address

2000 S IH 35 L-1
ROUND ROCK TX
78681-6900
US

V. Phone/Fax

Practice location:
  • Phone: 512-350-9515
  • Fax:
Mailing address:
  • Phone: 512-238-6200
  • Fax: 512-238-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5152
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1178723
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: