Provider Demographics
NPI:1508233628
Name:COLEMAN, KAMYLLE MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAMYLLE
Middle Name:MICHELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAMYLLE
Other - Middle Name:MICHELLE
Other - Last Name:PALOMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5446 N ACADEMY BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3669
Mailing Address - Country:US
Mailing Address - Phone:719-598-5555
Mailing Address - Fax:
Practice Address - Street 1:5446 N ACADEMY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3668
Practice Address - Country:US
Practice Address - Phone:719-598-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist