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General NPI Number Information
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NPI Number | 1528781697
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Entity Type | Individual
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Provider Name | MADELEINE COLLIER PTA
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Gender | Female
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 275 NEIGHBORHOOD WAY
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City | SPANISH SPRINGS
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State | NV
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Zip | 89441-9303
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Country | US
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Telephone | 775-424-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 1886 E OSAGE ORANGE AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-3524
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Country | US
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Telephone | 801-259-0629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 11153020-2402
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License Number State | UT
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