MEDICARE: BRIAN SCOTT COLLINS

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1598325979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN SCOTT COLLINS

Provider Business Mailing Address
First Line	:	9412 KIRKWOOD RD APT A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2606
Country	:	US
Telephone Number	:	609-238-7816
Fax Number	:

Provider Business Practice Location Address
First Line	:	10980 NORCOM RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2302
Country	:	US
Telephone Number	:	215-613-1070
Fax Number	:

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/18/2019

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