Individual
COLLIN COLEGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4324 W SAGINAW HWY STE A, LANSING, MI 48917-2163
(517) 220-6059
(517) 208-1803
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
(630) 928-5080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501017391
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M23560
GROUP MEDICARE PTAN
—
Enumeration date
08/11/2015
Last updated
02/06/2019
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