Provider Demographics
NPI:1972688042
Name:GINA R. COLLINS
Entity Type:Organization
Organization Name:GINA R. COLLINS
Other - Org Name:SIMI PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:805-581-4266
Mailing Address - Street 1:3200 E LOS ANGELES AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3972
Mailing Address - Country:US
Mailing Address - Phone:805-581-4266
Mailing Address - Fax:805-581-5049
Practice Address - Street 1:3200 E LOS ANGELES AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3972
Practice Address - Country:US
Practice Address - Phone:805-581-4266
Practice Address - Fax:805-581-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27129261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy