Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043556335 |
---|---|
Provider Name | Bartholomew Coleman |
First Address | Greenville, CA 95947-0554 |
Second Address | Greenville, CA 95947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2012 |
Last Update Date | 14/12/2012 |