Provider Demographics
NPI:1427005537
Name:MOROCCO-COLLINS, TINA R (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:R
Last Name:MOROCCO-COLLINS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11617 S ADA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5126
Mailing Address - Country:US
Mailing Address - Phone:773-469-1183
Mailing Address - Fax:773-568-5629
Practice Address - Street 1:11113 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3907
Practice Address - Country:US
Practice Address - Phone:773-469-1183
Practice Address - Fax:773-568-5629
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0098962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636233OtherBCBS PPO