Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 10026 | SC |
NPI | 1093320400 |
---|---|
Provider Name | William Travis Collins |
First Address | Drayton, SC 29333-0802 |
Second Address | Greenville, SC 29607-3503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2020 |
Last Update Date | 11/09/2020 |