Healthcare Provider Details

I. General information

NPI: 1831708221
Provider Name (Legal Business Name): JASON COLEMAN MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 UNIVERSITY DR
WEST LIBERTY WV
26074-1082
US

IV. Provider business mailing address

703 STONE SHANNON RD
WHEELING WV
26003-6744
US

V. Phone/Fax

Practice location:
  • Phone: 304-336-8093
  • Fax:
Mailing address:
  • Phone: 304-312-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT001314
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: