Healthcare Provider Details

I. General information

NPI: 1194356113
Provider Name (Legal Business Name): NICOLE SHERI COLEMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 W 21ST ST STE 103
NORFOLK VA
23517-1534
US

IV. Provider business mailing address

1450 KEMPSVILLE RD STE 102
VIRGINIA BEACH VA
23464-7320
US

V. Phone/Fax

Practice location:
  • Phone: 757-623-0867
  • Fax: 757-627-2923
Mailing address:
  • Phone: 757-481-6701
  • Fax: 757-481-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: