Provider Demographics
NPI:1598227993
Name:LEFEVOR, COLEMAN (DPT)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:
Last Name:LEFEVOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:3306 S HIGLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2209
Practice Address - Country:US
Practice Address - Phone:480-729-8315
Practice Address - Fax:480-542-6460
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZLPT-30616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist