Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | CA |
NPI | 1023689254 |
---|---|
Provider Name | Emily Marie Coleman |
First Address | Los Angeles, CA 90015-1470 |
Second Address | La Canada Flintridge, CA 91011-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 08/07/2021 |