MEDICARE: TARA L. COLLINS PT,CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	004078	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q32951	OTHER	NY	EMPIRE BLUE CROSS
2	080004078	OTHER	CT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1184696916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA L. COLLINS PT,CSCS

Provider Business Mailing Address
First Line	:	2889 FAIRFIELD AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06605-3211
Country	:	US
Telephone Number	:	203-345-1720
Fax Number	:	203-549-0725

Provider Business Practice Location Address
First Line	:	2889 FAIRFIELD AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06605-3211
Country	:	US
Telephone Number	:	203-345-1720
Fax Number	:	203-549-0725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	05/02/2018

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