Provider Demographics
NPI:1326324674
Name:COLEMAN, KWESI E (DPT, LMT)
Entity Type:Individual
Prefix:DR
First Name:KWESI
Middle Name:E
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MONTEREY OAKS BLVD APT 2228
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4365
Mailing Address - Country:US
Mailing Address - Phone:425-299-8640
Mailing Address - Fax:
Practice Address - Street 1:4600 MONTEREY OAKS BLVD APT 2228
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4365
Practice Address - Country:US
Practice Address - Phone:425-299-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60123594174400000X
TX120231225700000X
TX1309995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist