Provider Demographics
NPI:1629758222
Name:COLEMAN, REBECCA S (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIDGEMONT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2587
Mailing Address - Country:US
Mailing Address - Phone:918-237-5707
Mailing Address - Fax:
Practice Address - Street 1:65 N HARVARD ST
Practice Address - Street 2:DILLON FIELD HOUSE
Practice Address - City:ALLSTON
Practice Address - State:MI
Practice Address - Zip Code:02113
Practice Address - Country:US
Practice Address - Phone:617-495-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer