Provider Demographics
NPI:1518364678
Name:COLLINS, RACHEL (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NORMAN DR
Mailing Address - Street 2:APT Y-2
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-3200
Mailing Address - Country:US
Mailing Address - Phone:918-230-8411
Mailing Address - Fax:
Practice Address - Street 1:23 MDOS SGOY
Practice Address - Street 2:3278 MITCHELL BLVD
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699-0001
Practice Address - Country:US
Practice Address - Phone:229-257-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer