Provider Demographics
NPI:1972149821
Name:COLLINS, EMILY NICOLE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:NICOLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:NICOLE
Other - Last Name:SHIGENAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31271 NIGUEL RD STE J
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4135
Mailing Address - Country:US
Mailing Address - Phone:949-433-5442
Mailing Address - Fax:
Practice Address - Street 1:31271 NIGUEL RD STE J
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4135
Practice Address - Country:US
Practice Address - Phone:949-433-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT297530OtherPT LICENSE