Provider Demographics
NPI:1629327093
Name:COLLINS, BRANDI N (PT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:N
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 1:476 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-2049
Mailing Address - Country:US
Mailing Address - Phone:606-743-3186
Mailing Address - Fax:606-743-1693
Practice Address - Street 1:476 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-2049
Practice Address - Country:US
Practice Address - Phone:606-743-3186
Practice Address - Fax:606-743-1693
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY03947OtherKENTUCKY STATE LICENSE