Provider Demographics
NPI:1336112580
Name:COLLINS, JEFFREY AARON (ATC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:AARON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 W HALF MOON CIR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6641
Mailing Address - Country:US
Mailing Address - Phone:480-641-0467
Mailing Address - Fax:510-899-0924
Practice Address - Street 1:160 E 6TH PL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5068
Practice Address - Country:US
Practice Address - Phone:480-387-5800
Practice Address - Fax:480-387-5830
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer