Provider Demographics
NPI:1356583249
Name:COLEMAN, JACQUELINE (MASSAGE THERAPY)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HOLDER RD
Mailing Address - Street 2:
Mailing Address - City:BATESBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29006-9425
Mailing Address - Country:US
Mailing Address - Phone:803-609-5095
Mailing Address - Fax:
Practice Address - Street 1:129 HOLDER RD
Practice Address - Street 2:
Practice Address - City:BATESBURG
Practice Address - State:SC
Practice Address - Zip Code:29006-9425
Practice Address - Country:US
Practice Address - Phone:803-609-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist