Provider Demographics
NPI:1598030439
Name:COLEMAN, DONNA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 BLACKBURN AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-1866
Mailing Address - Country:US
Mailing Address - Phone:386-259-2072
Mailing Address - Fax:386-585-9877
Practice Address - Street 1:2860 BLACKBURN AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-1866
Practice Address - Country:US
Practice Address - Phone:386-259-2072
Practice Address - Fax:386-585-9877
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62846225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist