Provider Demographics
NPI:1932401858
Name:COLLIER, CHERYL MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 MOORE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9000
Mailing Address - Country:US
Mailing Address - Phone:707-951-4621
Mailing Address - Fax:
Practice Address - Street 1:306 WHARF ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-0401
Practice Address - Country:US
Practice Address - Phone:541-469-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7400225200000X, 225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant