MEDICARE: CARINNA L COLEMAN PT

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
1	225100000X	Physical Therapist	9582	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245244383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARINNA L COLEMAN PT

Provider Business Mailing Address
First Line	:	PO BOX 19070
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54307-9070
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 SHAWANO AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303-3268
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	11/03/2021

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Directions to “ CARINNA L COLEMAN PT” Practice Location

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