Provider Demographics
NPI:1407061724
Name:MARK L. COLLINS
Entity Type:Organization
Organization Name:MARK L. COLLINS
Other - Org Name:GOFFSTOWN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-497-8717
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-0545
Mailing Address - Country:US
Mailing Address - Phone:603-497-8717
Mailing Address - Fax:603-497-8711
Practice Address - Street 1:48 MAST RD
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2350
Practice Address - Country:US
Practice Address - Phone:603-497-8717
Practice Address - Fax:603-497-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30390434Medicaid
NHRE4118Medicare ID - Type Unspecified