Healthcare Provider Details

I. General information

NPI: 1992250427
Provider Name (Legal Business Name): MICHAEL WADE COLLINS PT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 STATE ST APT 3302
RICHARDSON TX
75082-2033
US

IV. Provider business mailing address

1250 STATE ST APT 3302
RICHARDSON TX
75082-2033
US

V. Phone/Fax

Practice location:
  • Phone: 318-680-5500
  • Fax: 501-325-2577
Mailing address:
  • Phone: 318-680-5500
  • Fax: 501-325-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT2750
License Number StateAR

VIII. Authorized Official

Name: MR. MICHAEL WADE COLLINS
Title or Position: PRESIDENT
Credential: PT
Phone: 318-680-5500