Provider Demographics
NPI:1043323322
Name:COLLINS, DEBRA LEE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17138 RAVENS ROOST APT 5
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4481
Mailing Address - Country:US
Mailing Address - Phone:239-433-4826
Mailing Address - Fax:
Practice Address - Street 1:999 TRAIL TERRACE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2305
Practice Address - Country:US
Practice Address - Phone:239-649-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist