MEDICARE: BRENDA JOYCE COLLINS LMT

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	174400000X	Specialist	LMT010926	TX

General Provider Information

NPI Number	:	1992703441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA JOYCE COLLINS LMT

Provider Business Mailing Address
First Line	:	2940 BROADWAY BLVD
Second Line	:	SUITE 107
City	:	GARLAND
State	:	TX
Zip	:	75041-3776
Country	:	US
Telephone Number	:	972-864-8226
Fax Number	:	775-414-5786

Provider Business Practice Location Address
First Line	:	2940 BROADWAY BLVD
Second Line	:	SUITE 107
City	:	GARLAND
State	:	TX
Zip	:	75041-3776
Country	:	US
Telephone Number	:	972-864-8226
Fax Number	:	775-414-5786

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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