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General NPI Number Information
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NPI Number | 1568980712
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Entity Type | Individual
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Provider Name | KAYLA SHINEW COLLINS PHD, AT, ROT
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Gender | Female
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | CALIFORNIA UNIVERSITY OF PA 250 UNIVERSITY DR. BOX #14
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City | CALIFORNIA
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State | PA
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Zip | 15419
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Country | US
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Telephone | 724-938-4823
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Fax |
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Provider Business Mailing Address
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Address Line | 250 UNIVERSITY AVE # 14
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City | CALIFORNIA
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State | PA
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Zip | 15419-1341
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Country | US
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Telephone | 724-938-4823
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT006527
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License Number State | PA
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