Provider Demographics
NPI:1982964391
Name:COLLINS, CHIANTI
Entity type:Individual
Prefix:
First Name:CHIANTI
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SIERRA VISTA DR
Mailing Address - Street 2:APT 8
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2920
Mailing Address - Country:US
Mailing Address - Phone:702-772-9438
Mailing Address - Fax:
Practice Address - Street 1:1004 SIERRA VISTA DR
Practice Address - Street 2:APT 8
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2920
Practice Address - Country:US
Practice Address - Phone:702-772-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty