Provider Demographics
NPI:1689101388
Name:COLLIER, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 DYKE RD
Mailing Address - Street 2:
Mailing Address - City:DYKE
Mailing Address - State:VA
Mailing Address - Zip Code:22935-1409
Mailing Address - Country:US
Mailing Address - Phone:434-990-9053
Mailing Address - Fax:
Practice Address - Street 1:8407 DYKE RD
Practice Address - Street 2:
Practice Address - City:DYKE
Practice Address - State:VA
Practice Address - Zip Code:22935-1409
Practice Address - Country:US
Practice Address - Phone:434-990-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260003372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer