Provider Demographics
NPI:1356979165
Name:COLLINS, DENNIS J (LMT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:GARRETT PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20896-0470
Mailing Address - Country:US
Mailing Address - Phone:301-946-7318
Mailing Address - Fax:
Practice Address - Street 1:11400 ROKEBY AVE
Practice Address - Street 2:
Practice Address - City:GARRETT PARK
Practice Address - State:MD
Practice Address - Zip Code:20896-1516
Practice Address - Country:US
Practice Address - Phone:301-946-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00590225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist