Provider Demographics
NPI:1831708221
Name:COLEMAN, JASON (MS, ATC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 STONE SHANNON RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6744
Mailing Address - Country:US
Mailing Address - Phone:304-312-8463
Mailing Address - Fax:
Practice Address - Street 1:208 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:WV
Practice Address - Zip Code:26074-1082
Practice Address - Country:US
Practice Address - Phone:304-336-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0013142081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine