MEDICARE: MS. LANAY MARRTENE COLEMAN MS, ATC

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	2255A2300X	Athletic Trainer	0126001398	VA

General Provider Information

NPI Number	:	1427289453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LANAY MARRTENE COLEMAN MS, ATC

Provider Business Mailing Address
First Line	:	532 CORAL KEY PL
Second Line	:	1C
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4335
Country	:	US
Telephone Number	:	757-243-8304
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 CORAL KEY PL
Second Line	:	1C
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4335
Country	:	US
Telephone Number	:	757-243-8304
Fax Number	:

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

Provider Enumeration Date	:	08/08/2009
Last Update Date	:	08/08/2009

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