Provider Demographics
NPI:1740821867
Name:COLEMAN, TOMEGA P (LMT)
Entity type:Individual
Prefix:
First Name:TOMEGA
Middle Name:P
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 OLD SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-3720
Mailing Address - Country:US
Mailing Address - Phone:804-898-8428
Mailing Address - Fax:
Practice Address - Street 1:4051 CHIPPENDALE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-3229
Practice Address - Country:US
Practice Address - Phone:804-898-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019009087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist