Provider Demographics
NPI:1336427764
Name:COLEMAN, HEIDI LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:HEIDI
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 1:122 NIMS SPRING DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6461
Mailing Address - Country:US
Mailing Address - Phone:803-547-0854
Mailing Address - Fax:
Practice Address - Street 1:122 NIMS SPRING DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6461
Practice Address - Country:US
Practice Address - Phone:909-553-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4342225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant