Provider Demographics
NPI:1366742546
Name:COLLINS, SANDRA ANN (PT)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
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:PO BOX 1807
Mailing Address - Street 2:389 KANE STREET
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-2753
Mailing Address - Country:US
Mailing Address - Phone:276-386-2424
Mailing Address - Fax:276-386-2349
Practice Address - Street 1:389 KANE STREET
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-2753
Practice Address - Country:US
Practice Address - Phone:276-386-2424
Practice Address - Fax:276-386-2349
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4979681Medicaid