Provider Demographics
NPI:1275102881
Name:COLLINS, ALICIA M
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:HOOKER
Mailing Address - State:OK
Mailing Address - Zip Code:73945-0797
Mailing Address - Country:US
Mailing Address - Phone:620-624-2980
Mailing Address - Fax:620-624-2985
Practice Address - Street 1:1452 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2212
Practice Address - Country:US
Practice Address - Phone:620-624-2980
Practice Address - Fax:620-624-2985
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist