Provider Demographics
NPI:1265975684
Name:COLEMAN, DEMETRIOUS ABDUL JR (PTA)
Entity type:Individual
Prefix:MR
First Name:DEMETRIOUS
Middle Name:ABDUL
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225-227 MCWHORTER ST.
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:971-494-0858
Mailing Address - Fax:844-857-2827
Practice Address - Street 1:225-227 MCWHORTER ST.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:973-494-0858
Practice Address - Fax:844-857-2827
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012511225200000X
TNPTA0000006080225200000X
NJ40QB00424900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant