Provider Demographics
NPI:1174735831
Name:COLLEWIJN, ROBERT (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:COLLEWIJN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1294
Mailing Address - Country:US
Mailing Address - Phone:727-223-9902
Mailing Address - Fax:727-223-9903
Practice Address - Street 1:305 N FORT HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-3923
Practice Address - Country:US
Practice Address - Phone:727-223-9902
Practice Address - Fax:727-223-9902
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501003347OtherTHERAPIST LICENSE