Provider Demographics
NPI:1205188315
Name:HITTLE, COLLIN L (PT)
Entity Type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:L
Last Name:HITTLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 W. CACTUS RD
Mailing Address - Street 2:OAKESON PHYSICAL THERAPY
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-878-9696
Mailing Address - Fax:623-776-0668
Practice Address - Street 1:8240 W. CACTUS RD
Practice Address - Street 2:OAKESON PHYSICAL THERAPY
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:602-878-9696
Practice Address - Fax:623-776-0668
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ388742Medicaid