Provider Demographics
NPI:1699070235
Name:COLLINS, CHRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 S GREEN BAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4468
Mailing Address - Country:US
Mailing Address - Phone:262-321-0240
Mailing Address - Fax:262-321-0242
Practice Address - Street 1:122 GREEN BAY RD STE 110
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1624
Practice Address - Country:US
Practice Address - Phone:262-395-9262
Practice Address - Fax:262-321-0242
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11276-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist