Provider Demographics
NPI:1588604169
Name:COLLINS, CARA A (PT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GANNETT DR STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5900
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:259 MAIN ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6723
Practice Address - Country:US
Practice Address - Phone:207-780-8860
Practice Address - Fax:207-523-8584
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5535176OtherCCN INDIV. #
ME022860OtherANTHEM ME INDIV. #
MEUX3850OtherMEDICARE PTAN
MEUX3850OtherMEDICARE PTAN
5535176OtherCCN INDIV. #