Provider Demographics
NPI:1336160720
Name:COLLINS, LOUANN C (RPT)
Entity Type:Individual
Prefix:
First Name:LOUANN
Middle Name:C
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:LOUANN
Other - Middle Name:C
Other - Last Name:CONNELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 MAJOR DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-7850
Mailing Address - Country:US
Mailing Address - Phone:864-388-9582
Mailing Address - Fax:
Practice Address - Street 1:310 CALHOUN AVE STE H
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-2028
Practice Address - Country:US
Practice Address - Phone:864-388-7529
Practice Address - Fax:864-388-7528
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1254Medicaid