Provider Demographics
NPI:1477276053
Name:COLES, IMANI L (PT, DPT)
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:L
Last Name:COLES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MAYLAND DR, STE 4379
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294
Mailing Address - Country:US
Mailing Address - Phone:804-840-4280
Mailing Address - Fax:
Practice Address - Street 1:8401 MAYLAND DR, STE 4379
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294
Practice Address - Country:US
Practice Address - Phone:804-840-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11376225100000X
VACP029992T225100000X
DEJ1-0014836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist