Provider Demographics
NPI:1417194655
Name:COLLINS, LAUREN HALLIE (MPT, CLT-LANA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:HALLIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MPT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43672 NOWLAND DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1787
Mailing Address - Country:US
Mailing Address - Phone:313-550-6367
Mailing Address - Fax:
Practice Address - Street 1:7610 PENNSYLVANIA AVE STE 305
Practice Address - Street 2:7525 GREENWAY CENTER DRIVE, STE216, GREENBELT, MD 20770
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4701
Practice Address - Country:US
Practice Address - Phone:313-550-6367
Practice Address - Fax:301-669-1873
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009596225100000X
MD24460225100000X
NY036196-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist