MEDICARE: TAMRA J 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	PT00002692	WA
2	225100000X	Physical Therapist	4732	OR
3	225100000X	Physical Therapist	25961	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	523039028	OTHER	OR	REGENCE BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396961140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMRA J COLEMAN PT

Provider Business Mailing Address
First Line	:	1977 ACOMA BLVD W
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-2958
Country	:	US
Telephone Number	:	928-302-5323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1977 ACOMA BLVD W
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-2958
Country	:	US
Telephone Number	:	928-302-5323
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	03/07/2017

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