Provider Demographics
NPI:1982863353
Name:COLEMAN, KELLY ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:ALAN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1342 E PRIMROSE STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4224
Mailing Address - Country:US
Mailing Address - Phone:417-890-7787
Mailing Address - Fax:417-890-9397
Practice Address - Street 1:1342 E PRIMROSE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4224
Practice Address - Country:US
Practice Address - Phone:417-890-7787
Practice Address - Fax:417-890-9397
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20040361792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic