MEDICARE: GERALD S COLEMAN P.T.

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	174400000X	Specialist	PT00000920	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	97699	OTHER	WA	L&I PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902806862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD S COLEMAN P.T.

Provider Business Mailing Address
First Line	:	2302 S UNION AVE
Second Line	:	SUITE B-10
City	:	TACOMA
State	:	WA
Zip	:	98405-1300
Country	:	US
Telephone Number	:	253-752-9303
Fax Number	:	253-756-7175

Provider Business Practice Location Address
First Line	:	2302 S UNION AVE
Second Line	:	SUITE B-10
City	:	TACOMA
State	:	WA
Zip	:	98405-1300
Country	:	US
Telephone Number	:	253-752-9303
Fax Number	:	253-756-7175

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/31/2010

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