Provider Demographics
NPI:1710182191
Name:COLLINS, MICHELLE SANDY (MS, ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SANDY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
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Mailing Address - Street 1:4537 ROSEDALE RD
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-4351
Mailing Address - Country:US
Mailing Address - Phone:225-268-1311
Mailing Address - Fax:225-344-6836
Practice Address - Street 1:1 NORTH STADIUM ROAD
Practice Address - Street 2:LSU-BROUSSARD ATHLETIC TRAINING ROOM
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70894
Practice Address - Country:US
Practice Address - Phone:225-578-2496
Practice Address - Fax:225-578-3924
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAATH.J003352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer