Provider Demographics
NPI:1891169686
Name:COLEMAN, TRACY III (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:
Last Name:COLEMAN
Suffix:III
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 ELDORADO PKWY
Mailing Address - Street 2:APT# 222
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 ELDORADO PKWY
Practice Address - Street 2:APT# 222
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3573
Practice Address - Country:US
Practice Address - Phone:410-533-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT58372083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine