Provider Demographics
NPI:1043789787
Name:COLLINS, KATHRYN E (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:E
Last Name:COLLINS
Suffix:
Gender:F
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 1:5060 CASCADE RD SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3808
Mailing Address - Country:US
Mailing Address - Phone:616-364-3290
Mailing Address - Fax:616-364-3299
Practice Address - Street 1:6290 JUPITER AVE NE STE C
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8885
Practice Address - Country:US
Practice Address - Phone:616-364-3290
Practice Address - Fax:616-364-3299
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist