Provider Demographics
NPI:1306948807
Name:COLLINS, MICHAEL WADE II (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WADE
Last Name:COLLINS
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 BAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8196
Mailing Address - Country:US
Mailing Address - Phone:318-680-5500
Mailing Address - Fax:318-680-5500
Practice Address - Street 1:4410 BAY HILL DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8196
Practice Address - Country:US
Practice Address - Phone:318-680-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT27502251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical