Provider Demographics
NPI:1922376078
Name:COLLINS, GREGORY A (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CYPRESS WAY E STE 65
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9275
Mailing Address - Country:US
Mailing Address - Phone:239-596-8530
Mailing Address - Fax:239-596-9883
Practice Address - Street 1:848 1ST AVE N
Practice Address - Street 2:SUITE 120
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6013
Practice Address - Country:US
Practice Address - Phone:239-384-5952
Practice Address - Fax:239-384-5970
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGF493Medicare PIN