Provider Demographics
NPI:1982142311
Name:COLLINS, BRYAN NELSON (DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:NELSON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2812
Mailing Address - Country:US
Mailing Address - Phone:910-944-1169
Mailing Address - Fax:910-944-1566
Practice Address - Street 1:200 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2812
Practice Address - Country:US
Practice Address - Phone:910-944-1169
Practice Address - Fax:910-944-1566
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16894225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic