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NPI Code Detail

MEDICARE: ZACHARY COLEMAN PT

MEDICARE: ZACHARY 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
1225100000XPhysical Therapist10013SC
2225100000XPhysical Therapist041649-1NY
3225100000XPhysical TherapistP18728NC

General Provider Information

NPI Number : 1568977577
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY COLEMAN PT
Provider Business Mailing Address
First Line : 4601 PARK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-2290
Country : US
Telephone Number : 704-323-3611
Fax Number :
Provider Business Practice Location Address
First Line : 5935 CARNEGIE BLVD STE 104
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-4672
Country : US
Telephone Number : 704-323-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2017
Last Update Date : 12/16/2024

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