Provider Demographics
NPI:1477289015
Name:COLEMAN, SHELBY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 CHARITY CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80530-4802
Mailing Address - Country:US
Mailing Address - Phone:720-438-5124
Mailing Address - Fax:
Practice Address - Street 1:6908 CHARITY CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80530-4802
Practice Address - Country:US
Practice Address - Phone:720-438-5124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0015178208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation