Provider Demographics
NPI:1407221955
Name:COLLINS, JERROD
Entity Type:Individual
Prefix:
First Name:JERROD
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 S EMPORIA WAY
Mailing Address - Street 2:UNIT M107
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-7238
Mailing Address - Country:US
Mailing Address - Phone:910-987-7688
Mailing Address - Fax:
Practice Address - Street 1:3785 S EMPORIA WAY
Practice Address - Street 2:UNIT M107
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-7238
Practice Address - Country:US
Practice Address - Phone:910-987-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist