Provider Demographics
NPI:1700222825
Name:COLEMAN, AARON JAHMAAL
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JAHMAAL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 BLACK OAKS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2045
Mailing Address - Country:US
Mailing Address - Phone:702-376-3570
Mailing Address - Fax:
Practice Address - Street 1:6520 BLACK OAKS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2045
Practice Address - Country:US
Practice Address - Phone:702-376-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner