| Organization Name: | COLLINSVILLE PHYSICAL THERAPY CLINIC, LLC |
| NPI Number: | 1831394196 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEWAYNA LEA ROBERTS (OFFICW MANAGER) |
| Mailing Address: | 9099 Collinsville Rd # A Collinsville |
| State: | MS US |
| Postal Code: | 393259779 |
| Phone Number: | 6016268885 |
| Fax Number: | 6016268885 |
| NPI Enumeration Date: | 06/18/2007 |
| NPI Last Update Date: | 11/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT3002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |