Provider Demographics
NPI:1528698768
Name:COLLINS, KEVIN THOMAS (LMT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 N HEARSEY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-3099
Mailing Address - Country:US
Mailing Address - Phone:240-888-6976
Mailing Address - Fax:
Practice Address - Street 1:5107 N HEARSEY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-3099
Practice Address - Country:US
Practice Address - Phone:240-888-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT113058172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist