Provider Demographics
NPI:1609242338
Name:DOE, COLLETTE WADE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:WADE
Last Name:DOE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:COLLETTE
Other - Middle Name:LYNN
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:195 DROOS WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6861
Mailing Address - Country:US
Mailing Address - Phone:803-230-1402
Mailing Address - Fax:
Practice Address - Street 1:721 WAPPOO RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5861
Practice Address - Country:US
Practice Address - Phone:843-403-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist