Provider Demographics
NPI:1437484151
Name:COLLIER, JOSHUA (LMT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 E IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-3821
Mailing Address - Country:US
Mailing Address - Phone:813-933-4506
Mailing Address - Fax:
Practice Address - Street 1:3105 W WATERS AVE
Practice Address - Street 2:STE 304
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2869
Practice Address - Country:US
Practice Address - Phone:813-933-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56803225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist