Provider Demographics
NPI:1700231453
Name:COLLINS, MEGAN (DAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:KINSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3426 KNOX AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2450
Mailing Address - Country:US
Mailing Address - Phone:612-386-8770
Mailing Address - Fax:
Practice Address - Street 1:1815 4TH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-2007
Practice Address - Country:US
Practice Address - Phone:612-618-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29352255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer