Provider Demographics
NPI:1093364861
Name:COLLINGS, TARA (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:
Last Name:COLLINGS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-2763
Mailing Address - Country:US
Mailing Address - Phone:417-667-8181
Mailing Address - Fax:
Practice Address - Street 1:1000 W AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2763
Practice Address - Country:US
Practice Address - Phone:417-667-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer