Provider Demographics
NPI:1508099326
Name:COLLINS, SHAWN MICHAEL (MSPT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MSPT
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Mailing Address - Street 1:2120 43RD ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3772
Mailing Address - Country:US
Mailing Address - Phone:616-281-1144
Mailing Address - Fax:616-281-1221
Practice Address - Street 1:9028 N. ROGERS DR.
Practice Address - Street 2:SUITE J
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9823
Practice Address - Country:US
Practice Address - Phone:616-891-0600
Practice Address - Fax:616-891-0660
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2012-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501011150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist