Provider Demographics
NPI:1023106051
Name:COLLINS, CYNTHIA LOUISE (DC, RPT)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 FLORENCITA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1817
Mailing Address - Country:US
Mailing Address - Phone:818-248-0033
Mailing Address - Fax:818-248-7633
Practice Address - Street 1:2317 FLORENCITA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1817
Practice Address - Country:US
Practice Address - Phone:818-248-0033
Practice Address - Fax:818-248-7633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22632111N00000X
CAPT9058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist