Provider Demographics
NPI:1356555841
Name:COLLINS, AMY M (MT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2565
Mailing Address - Country:US
Mailing Address - Phone:216-739-1930
Mailing Address - Fax:216-739-9668
Practice Address - Street 1:1356 COOK AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2565
Practice Address - Country:US
Practice Address - Phone:216-739-1930
Practice Address - Fax:216-739-9668
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10000172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist