Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT1442 | AR |
NPI | 1043381148 |
---|---|
Provider Name | Ms. Jan Elizabeth Collins |
First Address | England, AR 72046-9674 |
Second Address | North Little Rock, AR 72114-2326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 28/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139223721 | (05) | AR |