Provider Demographics
NPI:1750428215
Name:COLLINS, WILLIAM HENRY JR (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:COLLINS
Suffix:JR
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 1:40482 CLYBOURNE CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4753
Mailing Address - Country:US
Mailing Address - Phone:951-704-4040
Mailing Address - Fax:
Practice Address - Street 1:40675 CALIFORNIA OAKS RD
Practice Address - Street 2:UNIT D
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5790
Practice Address - Country:US
Practice Address - Phone:951-704-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16018225100000X
CA16018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 16018OtherPHYSICAL THERAPY LICENSE