Provider Demographics
NPI:1760650659
Name:COLEMAN, MONICA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-1031
Mailing Address - Country:US
Mailing Address - Phone:517-599-6536
Mailing Address - Fax:
Practice Address - Street 1:1587 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1279
Practice Address - Country:US
Practice Address - Phone:832-671-8641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
TX3105130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist