Basic Information
| Provider Information | |||||||||
| NPI: | 1194356113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | SHERI | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 KEMPSVILLE RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234647320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574816701 | ||||||||
| FaxNumber: | 7574816175 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 W 21ST ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235171534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576230867 | ||||||||
| FaxNumber: | 7576272923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2306602876 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.