Individual
TARA L. COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT,CSCS
Contact information
Practice address
2889 FAIRFIELD AVE, BRIDGEPORT, CT 06605-3211
(203) 345-1720
(203) 549-0725
Mailing address
2889 FAIRFIELD AVE, BRIDGEPORT, CT 06605-3211
(203) 345-1720
(203) 549-0725
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
004078
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080004078
BLUE CROSS BLUE SHIELD
CT
01
—
Q32951
EMPIRE BLUE CROSS
NY
Enumeration date
02/06/2006
Last updated
05/02/2018
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