Provider Demographics
NPI:1114052339
Name:COLEMAN, RON E II (PT)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:E
Last Name:COLEMAN
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10459 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2033
Mailing Address - Country:US
Mailing Address - Phone:909-478-9508
Mailing Address - Fax:909-478-9518
Practice Address - Street 1:10459 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2033
Practice Address - Country:US
Practice Address - Phone:909-478-9508
Practice Address - Fax:909-478-9518
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT279420Medicare PIN
CAZZZ23993ZMedicare PIN