Provider Demographics
NPI:1952472714
Name:COLEMAN, REBEKAH LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 EISENHOWER AVE
Mailing Address - Street 2:#177
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4884
Mailing Address - Country:US
Mailing Address - Phone:571-643-6877
Mailing Address - Fax:
Practice Address - Street 1:4800 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5070
Practice Address - Country:US
Practice Address - Phone:703-824-1244
Practice Address - Fax:703-824-1029
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601997225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant