Provider Demographics
NPI:1902806862
Name:COLEMAN, GERALD S (PT)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:S
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 S UNION AVE
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1300
Mailing Address - Country:US
Mailing Address - Phone:253-752-9303
Mailing Address - Fax:253-756-7175
Practice Address - Street 1:2302 S UNION AVE
Practice Address - Street 2:SUITE B-10
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1300
Practice Address - Country:US
Practice Address - Phone:253-752-9303
Practice Address - Fax:253-756-7175
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA97699OtherL&I PROVIDER NUMBER
WA7011869Medicaid
WA7011869Medicaid