MEDICARE: MRS. MARIE ELDA COLEMAN RT10762

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	227900000X	Registered Respiratory Therapist	RT10762	FL
2	2278G1100X	General Care Certified Respiratory Therapist	RT110762	FL

General Provider Information

NPI Number	:	1558850198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE ELDA COLEMAN RT10762

Provider Business Mailing Address
First Line	:	779 COTTON BAY DR W APT 1102
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-9055
Country	:	US
Telephone Number	:	561-260-9239
Fax Number	:

Provider Business Practice Location Address
First Line	:	779 COTTON BAY DR W APT 1102
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-9055
Country	:	US
Telephone Number	:	561-260-9239
Fax Number	:

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	05/09/2018

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