Provider Demographics
NPI:1336628197
Name:COLLINS, TRACEY REGENE (PTA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:REGENE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5840
Mailing Address - Country:US
Mailing Address - Phone:615-594-1266
Mailing Address - Fax:
Practice Address - Street 1:2871 HIGHWAY 31 W
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-5226
Practice Address - Country:US
Practice Address - Phone:615-672-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005548225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant