Provider Demographics
NPI:1730470345
Name:COLLINS, TRACY (PT, DPT, MS, CNS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT, DPT, MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 CHAMPIONS CLOSE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-0949
Mailing Address - Country:US
Mailing Address - Phone:678-224-8283
Mailing Address - Fax:
Practice Address - Street 1:760 CHAMPIONS CLOSE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-0949
Practice Address - Country:US
Practice Address - Phone:678-224-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011231225100000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist