MEDICARE: SPENCER THOMAS COLLINS PTA

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	225200000X	Physical Therapy Assistant	2013038749	MO

General Provider Information

NPI Number	:	1821770900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER THOMAS COLLINS PTA

Provider Business Mailing Address
First Line	:	2708 SAINT LOUIS RD APT C
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-4477
Country	:	US
Telephone Number	:	314-798-3662
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 COOK AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3801
Country	:	US
Telephone Number	:	314-798-3662
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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