Provider Demographics
NPI:1376550079
Name:COLLINS, WILLIAM A (MSPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019
Mailing Address - Country:US
Mailing Address - Phone:508-966-2717
Mailing Address - Fax:508-966-2095
Practice Address - Street 1:40 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019
Practice Address - Country:US
Practice Address - Phone:508-966-2717
Practice Address - Fax:508-966-2095
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COY69025Medicare ID - Type Unspecified