Provider Demographics
NPI:1083760037
Name:COLLINS, BRENDA M (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16280 SE 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-7037
Mailing Address - Country:US
Mailing Address - Phone:631-806-1422
Mailing Address - Fax:352-693-2102
Practice Address - Street 1:16280 SE 88TH AVE
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-7037
Practice Address - Country:US
Practice Address - Phone:631-806-1422
Practice Address - Fax:352-693-2102
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30120222Q00000X, 2251P0200X
NY012846-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist