Provider Demographics
NPI:1245368687
Name:COLLINS, EUGENE J (MPT)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 GATEWAY BLVD STE 211B
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5597
Mailing Address - Country:US
Mailing Address - Phone:704-662-0386
Mailing Address - Fax:704-662-0846
Practice Address - Street 1:108 GATEWAY BLVD STE 211B
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5597
Practice Address - Country:US
Practice Address - Phone:704-662-0386
Practice Address - Fax:704-662-0846
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist