Provider Demographics
NPI:1225325236
Name:COLLIER, ROOSEVELT III (PT)
Entity Type:Individual
Prefix:MR
First Name:ROOSEVELT
Middle Name:
Last Name:COLLIER
Suffix:III
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 1:10632 LITTLE PATUXENT PKWY STE 123
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6285
Mailing Address - Country:US
Mailing Address - Phone:443-917-2973
Mailing Address - Fax:443-917-2983
Practice Address - Street 1:4201 MITCHELLVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-464-5444
Practice Address - Fax:301-464-9444
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist