Provider Demographics
NPI:1720220486
Name:COLLINS, JOHN LEE (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1564
Mailing Address - Country:US
Mailing Address - Phone:606-269-8588
Mailing Address - Fax:
Practice Address - Street 1:115 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1564
Practice Address - Country:US
Practice Address - Phone:606-269-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1720220486Medicare UPIN