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General NPI Number Information
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NPI Number | 1295020899
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Entity Type | Individual
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Provider Name | CHARLENE COLEMAN LMT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 27405 US HIGHWAY 27 STE 115
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City | LEESBURG
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State | FL
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Zip | 34748-7914
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Country | US
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Telephone | 352-409-1481
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Fax | 352-343-7577
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | TAVARES
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State | FL
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Zip | 32778-0040
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Country | US
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Telephone | 352-409-1481
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Fax | 352-343-7577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA24707
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License Number State | FL
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