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NPI Code Detail

MEDICARE: PETER COLEMAN GRADER OTR/L

MEDICARE: PETER COLEMAN GRADER OTR/L
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
1208100000XPhysical Medicine & Rehabilitation Physician102507TX
2225X00000XOccupational Therapist102507TX

General Provider Information

NPI Number : 1245005099
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER COLEMAN GRADER OTR/L
Provider Business Mailing Address
First Line : 417 DOVE LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-3793
Country : US
Telephone Number : 817-223-7734
Fax Number :
Provider Business Practice Location Address
First Line : 4109 WESTRIDGE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-7403
Country : US
Telephone Number : 817-813-9431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2023
Last Update Date : 11/21/2023

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Directions to “ PETER COLEMAN GRADER OTR/L” Practice Location

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