Provider Demographics
NPI:1720014590
Name:COLLINS, MARCHELL MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARCHELL
Middle Name:MARIE
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 1:8941 S DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137
Mailing Address - Country:US
Mailing Address - Phone:918-488-0053
Mailing Address - Fax:
Practice Address - Street 1:3027 S NEW HAVEN
Practice Address - Street 2:TULSA PUBLIC SCHOOL DISTRICT
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74147
Practice Address - Country:US
Practice Address - Phone:918-746-6328
Practice Address - Fax:918-746-6341
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100635020DMedicaid