MEDICARE: ANNA COLLIER MPT

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	225100000X	Physical Therapist	PT 31164	FL

General Provider Information

NPI Number	:	1639102429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA COLLIER MPT

Provider Business Mailing Address
First Line	:	1801 NE 21ST ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3209
Country	:	US
Telephone Number	:	954-422-2234
Fax Number	:	954-422-2234

Provider Business Practice Location Address
First Line	:	1801 NE 21ST ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3209
Country	:	US
Telephone Number	:	954-422-2234
Fax Number	:	954-422-2234

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/03/2016

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