Provider Demographics
NPI:1699091082
Name:COLLINS, CRYSTAL MICHELLE (PTA)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 FILLMORE ST
Mailing Address - Street 2:APT. 408
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1616
Mailing Address - Country:US
Mailing Address - Phone:870-761-4435
Mailing Address - Fax:
Practice Address - Street 1:1620 FILLMORE ST
Practice Address - Street 2:APT. 408
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1616
Practice Address - Country:US
Practice Address - Phone:870-761-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 1905225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant