Provider Demographics
NPI:1578754073
Name:COLEMAN, ADRIANNE RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:RENEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ADRIANNE
Other - Middle Name:RENEE
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1519 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2918
Mailing Address - Country:US
Mailing Address - Phone:803-779-8327
Mailing Address - Fax:803-799-3603
Practice Address - Street 1:6041 GARNERS FERRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1304
Practice Address - Country:US
Practice Address - Phone:803-783-0684
Practice Address - Fax:803-783-1147
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1124249917OtherSATELLITE OFFICE NPI
SC5542OtherSC PT LICENSE
SC1285798231OtherSATELLITE OFFICE NPI
SC1285699249OtherPRACTICE NPI
SC426542OtherMEDICARE PROVIDER ID