MEDICARE: LISA COLEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		PA

General Provider Information

NPI Number	:	1063345650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA COLEMAN

Provider Business Mailing Address
First Line	:	1704 65TH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3412
Country	:	US
Telephone Number	:	267-901-3039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 65TH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3412
Country	:	US
Telephone Number	:	267-901-3039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ LISA COLEMAN ” Practice Location

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