Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003318171 |
---|---|
Provider Name | Bret Coleman |
First Address | Houston, TX 77056-4689 |
Second Address | Houston, TX 77056-4689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2018 |
Last Update Date | 05/03/2018 |