Provider Demographics
NPI:1649329525
Name:COLEMAN, SERENA (MPT)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 9TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2501
Mailing Address - Country:US
Mailing Address - Phone:509-326-8878
Mailing Address - Fax:509-326-1157
Practice Address - Street 1:315 W 9TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2501
Practice Address - Country:US
Practice Address - Phone:509-326-8878
Practice Address - Fax:509-326-1157
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0008218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202240OtherL & I PIN