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General NPI Number Information
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NPI Number | 1548790769
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Entity Type | Individual
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Provider Name | TIMOTHY COLLINS PT, DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 06/20/2017
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Provider Practice Location Address
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Address Line | 1755 GA-34 SUITE 1300, REHAB DEPARTMENT
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone | 770-254-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 3 PALLADIO WAY
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City | NEWNAN
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State | GA
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Zip | 30263-6976
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Country | US
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Telephone | 404-805-9147
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT012868
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License Number State | GA
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