Provider Demographics
NPI:1962845974
Name:COLLINS II, GARY LEE II (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:COLLINS II
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1333 CLARKS DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-3144
Mailing Address - Country:US
Mailing Address - Phone:325-677-1564
Mailing Address - Fax:325-232-8629
Practice Address - Street 1:1290 S WILLIS ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4068
Practice Address - Country:US
Practice Address - Phone:325-518-7066
Practice Address - Fax:325-232-8629
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067361171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor