Provider Demographics
NPI:1508146432
Name:COLEMAN, SHENTWAY KENTOYA
Entity Type:Individual
Prefix:MS
First Name:SHENTWAY
Middle Name:KENTOYA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 WINDSORMEADE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2791
Mailing Address - Country:US
Mailing Address - Phone:757-229-2808
Mailing Address - Fax:757-229-2059
Practice Address - Street 1:3900 WINDSORMEADE DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2791
Practice Address - Country:US
Practice Address - Phone:757-229-2808
Practice Address - Fax:757-229-2059
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603146225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant