Provider Demographics
NPI:1255986519
Name:COLLS, ZACHARY ROBERT (PT, DPT, CSCS, USA-W)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ROBERT
Last Name:COLLS
Suffix:
Gender:M
Credentials:PT, DPT, CSCS, USA-W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16200 NW 59TH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7541
Mailing Address - Country:US
Mailing Address - Phone:757-262-8902
Mailing Address - Fax:
Practice Address - Street 1:16200 NW 59TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7541
Practice Address - Country:US
Practice Address - Phone:757-262-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist