Provider Demographics
NPI:1457416406
Name:COLLIER, DAMON O (PT)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:O
Last Name:COLLIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49445 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5498
Mailing Address - Country:US
Mailing Address - Phone:586-321-7606
Mailing Address - Fax:
Practice Address - Street 1:23829 LITTLE MACK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1186
Practice Address - Country:US
Practice Address - Phone:586-416-4281
Practice Address - Fax:586-412-8757
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP33330002OtherMEDICARE PTAN
MI23-0165Medicare ID - Type Unspecified