Provider Demographics
NPI:1063571826
Name:COLLINS, ANDREA MARGAUX (PT)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:MARGAUX
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 1:5310 HARVEST RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-3108
Mailing Address - Country:US
Mailing Address - Phone:205-437-8081
Mailing Address - Fax:
Practice Address - Street 1:631 BEACON PKWY W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3124
Practice Address - Country:US
Practice Address - Phone:205-945-4859
Practice Address - Fax:205-945-8605
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH3695OtherPHYSICAL THERAPY LICENSE