Provider Demographics
NPI:1801253810
Name:COLESHILL, PEARL (ATC, LAT)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:COLESHILL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 BROMPTON LN
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5611
Mailing Address - Country:US
Mailing Address - Phone:803-325-5429
Mailing Address - Fax:
Practice Address - Street 1:3121 UNIVERSITY DRIVE E.
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-776-0169
Practice Address - Fax:979-776-1372
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT64042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer