MEDICARE: MR. MICHAEL WADE COLLINS II P.T.

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	2251E1300X	Clinical Electrophysiology Physical Therapist	PT2750	AR

General Provider Information

NPI Number	:	1306948807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL WADE COLLINS II P.T.

Provider Business Mailing Address
First Line	:	4410 BAY HILL DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8196
Country	:	US
Telephone Number	:	318-680-5500
Fax Number	:	318-680-5500

Provider Business Practice Location Address
First Line	:	4410 BAY HILL DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8196
Country	:	US
Telephone Number	:	318-680-5500
Fax Number	:

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

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	09/25/2012

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