Provider Demographics
NPI:1043999402
Name:COLEMAN, KEAIREZ JAWON (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEAIREZ
Middle Name:JAWON
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ROBINSON COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39082-4137
Mailing Address - Country:US
Mailing Address - Phone:601-660-2117
Mailing Address - Fax:
Practice Address - Street 1:1 BUCCANEER PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5701
Practice Address - Country:US
Practice Address - Phone:601-660-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT388372251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports