Provider Demographics
NPI:1346401551
Name:COLLINS, MARY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY LYNN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHERRYHURST LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1168
Mailing Address - Country:US
Mailing Address - Phone:724-873-0681
Mailing Address - Fax:
Practice Address - Street 1:1258 PURDYTOWN TPKE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18438-6793
Practice Address - Country:US
Practice Address - Phone:570-226-3321
Practice Address - Fax:505-468-9219
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007770L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist