Provider Demographics
NPI:1356787204
Name:COLEMAN, JUSTIN PARKER (DPT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:PARKER
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 OLYMPIA CIR
Mailing Address - Street 2:APT. 308
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-5463
Mailing Address - Country:US
Mailing Address - Phone:423-506-4022
Mailing Address - Fax:
Practice Address - Street 1:1561 OLYMPIA CIR
Practice Address - Street 2:APT. 308
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-5463
Practice Address - Country:US
Practice Address - Phone:423-506-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist