Provider Demographics
NPI:1124470349
Name:COLEMAN, CRAIG C (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:C
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 S. 216TH ST
Mailing Address - Street 2:#B203
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198
Mailing Address - Country:US
Mailing Address - Phone:425-269-9560
Mailing Address - Fax:
Practice Address - Street 1:1208 S. 216TH ST
Practice Address - Street 2:#B203
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198
Practice Address - Country:US
Practice Address - Phone:425-269-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60499234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist