MEDICARE: TOMEGA P. COLEMAN LMT

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	225700000X	Massage Therapist	0019009087	VA

General Provider Information

NPI Number	:	1740821867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMEGA P. COLEMAN LMT

Provider Business Mailing Address
First Line	:	4163 OLD SHORE RD
Second Line	:
City	:	BLACKSTONE
State	:	VA
Zip	:	23824-3720
Country	:	US
Telephone Number	:	804-898-8428
Fax Number	:

Provider Business Practice Location Address
First Line	:	4051 CHIPPENDALE DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-3229
Country	:	US
Telephone Number	:	804-898-8428
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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