Provider Demographics
NPI:1326397456
Name:COLLINS, JEANNETTE MARIE (PT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:MARIE
Other - Last Name:COUTURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,ATC
Mailing Address - Street 1:2764 HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2546
Mailing Address - Country:US
Mailing Address - Phone:646-734-0529
Mailing Address - Fax:
Practice Address - Street 1:2764 HARVEY AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2546
Practice Address - Country:US
Practice Address - Phone:646-734-0529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034652-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist