Basic Information
| Provider Information | |||||||||
| NPI: | 1770798381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | FAY | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 CRAGSMOOR RD | ||||||||
| Address2: | |||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210424907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104188561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6300 WOODSIDE CT | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210461098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103129000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16337 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.