Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1033634811 |
---|---|
Provider Name | Lauren Coleman |
First Address | Macon, GA 31210-2404 |
Second Address | Macon, GA 31210-2404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300022345A | (05) | GA |