Provider Demographics
NPI:1245967926
Name:COLLINS, MEGHAN BOUQUET (DPT)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:BOUQUET
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:MEGHAN
Other - Middle Name:BOUQUET
Other - Last Name:HENRIKSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 N LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:56057-1217
Mailing Address - Country:US
Mailing Address - Phone:507-469-4001
Mailing Address - Fax:
Practice Address - Street 1:1431 PREMIER DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-386-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist