Provider Demographics
NPI:1902141849
Name:COLEMAN, WENDY (RPT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMILY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3136
Mailing Address - Country:US
Mailing Address - Phone:860-561-7022
Mailing Address - Fax:860-313-5439
Practice Address - Street 1:1 EMILY WAY
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3136
Practice Address - Country:US
Practice Address - Phone:860-561-7022
Practice Address - Fax:860-313-5439
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist