Provider Demographics
NPI:1881677573
Name:COLLINS, LAURA (PT CHT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34220-0820
Mailing Address - Country:US
Mailing Address - Phone:941-729-1738
Mailing Address - Fax:941-722-7844
Practice Address - Street 1:506 4TH AVE W
Practice Address - Street 2:BLDG 4
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5203
Practice Address - Country:US
Practice Address - Phone:941-729-1800
Practice Address - Fax:941-722-7844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY900TOtherBLUE SHIELD
FLY900VOtherBLUE SHIELD
P00208111OtherRAILROAD MEDICARE
FLY900UOtherBLUE SHIED
FLY900TOtherBLUE SHIELD