Provider Demographics
NPI:1194186494
Name:COLLIS, MEGAN ANN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ANN
Last Name:COLLIS
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 1:2400 CHESTNUT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8321
Mailing Address - Country:US
Mailing Address - Phone:847-657-3520
Mailing Address - Fax:847-657-3521
Practice Address - Street 1:2400 CHESTNUT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8321
Practice Address - Country:US
Practice Address - Phone:847-657-3520
Practice Address - Fax:847-657-3521
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist