Provider Demographics
NPI:1396177234
Name:SCOLLINS, IAN (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:SCOLLINS
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 HERLONG AVE S STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1091
Mailing Address - Country:US
Mailing Address - Phone:839-274-3013
Mailing Address - Fax:839-274-3014
Practice Address - Street 1:420 SOUTH HERLONG AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1091
Practice Address - Country:US
Practice Address - Phone:839-274-3013
Practice Address - Fax:839-274-3014
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist