Provider Demographics
NPI:1679095715
Name:COLEMAN, JOY (PT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:260 1ST AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4364
Mailing Address - Country:US
Mailing Address - Phone:727-308-9848
Mailing Address - Fax:727-502-6027
Practice Address - Street 1:6775 40TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4939
Practice Address - Country:US
Practice Address - Phone:727-803-1102
Practice Address - Fax:727-502-6027
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist