Provider Demographics
NPI:1932186087
Name:MCCOLLOW, CONNIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:MCCOLLOW
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 1:9190 N. COACHLINE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743
Mailing Address - Country:US
Mailing Address - Phone:520-308-4878
Mailing Address - Fax:520-308-4874
Practice Address - Street 1:9190 N. COACHLINE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743
Practice Address - Country:US
Practice Address - Phone:520-308-4878
Practice Address - Fax:520-308-4874
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1219225100000X
AZLPT-001219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71846Medicare ID - Type Unspecified