Provider Demographics
NPI:1548789886
Name:COLEMAN, JENNIFER PATTERSON (LMBT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PATTERSON
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W KING ST STE 2
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3437
Mailing Address - Country:US
Mailing Address - Phone:704-739-3373
Mailing Address - Fax:
Practice Address - Street 1:110 W KING ST STE 2
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3437
Practice Address - Country:US
Practice Address - Phone:704-739-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13420OtherSTATE LICENSE