Provider Demographics
NPI:1770118952
Name:COLEMAN, ALISSA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:COLEMAN
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 1:10714 POTOMAC TENNIS LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4418
Mailing Address - Country:US
Mailing Address - Phone:301-299-2273
Mailing Address - Fax:
Practice Address - Street 1:10714 POTOMAC TENNIS LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4418
Practice Address - Country:US
Practice Address - Phone:301-299-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty