=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194356113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE SHERI COLEMAN PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2020
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 951 W 21ST ST STE 103
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23517-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-623-0867
-----------------------------------------------------
Fax | 757-627-2923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1450 KEMPSVILLE RD STE 102
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-7320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-481-6701
-----------------------------------------------------
Fax | 757-481-6175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2306602876
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------