Provider Demographics
NPI:1043381148
Name:COLLINS, JAN ELIZABETH (MPT)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:ELIZABETH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21704 HIGHWAY 161 S
Mailing Address - Street 2:
Mailing Address - City:ENGLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72046-9674
Mailing Address - Country:US
Mailing Address - Phone:501-487-8305
Mailing Address - Fax:
Practice Address - Street 1:2400 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2326
Practice Address - Country:US
Practice Address - Phone:501-487-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT14422251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139223721Medicaid