Provider Demographics
NPI:1902159114
Name:COLEMAN-JOHNSON, ELINDRA (PT)
Entity Type:Individual
Prefix:
First Name:ELINDRA
Middle Name:
Last Name:COLEMAN-JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 CHESDIN LANDING TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-3242
Mailing Address - Country:US
Mailing Address - Phone:843-743-5819
Mailing Address - Fax:
Practice Address - Street 1:15601 CHESDIN LANDING TER
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-3242
Practice Address - Country:US
Practice Address - Phone:843-743-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist