Provider Demographics
NPI:1578049946
Name:COLLINGS, SHELLY RANAE (LMT)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RANAE
Last Name:COLLINGS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 FALLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-1745
Mailing Address - Country:US
Mailing Address - Phone:610-310-5812
Mailing Address - Fax:610-323-4021
Practice Address - Street 1:1024 FALLBROOK LN
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-1745
Practice Address - Country:US
Practice Address - Phone:610-310-5812
Practice Address - Fax:610-323-4021
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG012159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist