Provider Demographics
NPI:1033387220
Name:COLLINS, DEMETRIUS RAY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIUS
Middle Name:RAY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S IH 35
Mailing Address - Street 2:L-1
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6900
Mailing Address - Country:US
Mailing Address - Phone:512-238-6200
Mailing Address - Fax:512-238-6700
Practice Address - Street 1:1015 BEECAVE WOODS DR STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6752
Practice Address - Country:US
Practice Address - Phone:512-350-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51522255A2300X
TX1178723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L26439Medicare PIN
TX8L26439Medicare UPIN