Provider Demographics
NPI:1548876550
Name:COLLARD, ADDISON DUANE (DPT)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:DUANE
Last Name:COLLARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1449
Mailing Address - Country:US
Mailing Address - Phone:801-971-8077
Mailing Address - Fax:
Practice Address - Street 1:1607 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3455
Practice Address - Country:US
Practice Address - Phone:641-828-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11276191-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist