Provider Demographics
NPI:1598325979
Name:COLLINS, BRIAN SCOTT
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:JULIAN
Other - Last Name:CARBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9412 KIRKWOOD RD APT A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2606
Mailing Address - Country:US
Mailing Address - Phone:609-238-7816
Mailing Address - Fax:
Practice Address - Street 1:10980 NORCOM RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-2302
Practice Address - Country:US
Practice Address - Phone:215-613-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer