Provider Demographics
NPI:1780810366
Name:COLLINS, KAREN E (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HARVEST RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-7269
Mailing Address - Country:US
Mailing Address - Phone:207-843-6822
Mailing Address - Fax:866-220-5031
Practice Address - Street 1:170 HARVEST RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:ME
Practice Address - Zip Code:04429-7269
Practice Address - Country:US
Practice Address - Phone:207-843-6822
Practice Address - Fax:866-220-5031
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038035OtherANTHEM OF MAINE
MEP00736457OtherRR MEDICARE
ME001132701Medicare PIN