Provider Demographics
NPI:1740761428
Name:COLLEGNON, KRISTINA (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:COLLEGNON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1276
Mailing Address - Country:US
Mailing Address - Phone:906-789-2404
Mailing Address - Fax:906-789-2405
Practice Address - Street 1:501 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1276
Practice Address - Country:US
Practice Address - Phone:906-789-2404
Practice Address - Fax:906-789-2405
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty