Provider Demographics
NPI:1356840474
Name:COLEMAN, CAROLYNN L (LMT)
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 NW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-1001
Mailing Address - Country:US
Mailing Address - Phone:515-360-7600
Mailing Address - Fax:
Practice Address - Street 1:932 SW HURBERT ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4715
Practice Address - Country:US
Practice Address - Phone:515-360-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist