Provider Demographics
NPI:1043445281
Name:COLEMAN, KATIE (DPT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 ERMINE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4131
Mailing Address - Country:US
Mailing Address - Phone:937-725-8169
Mailing Address - Fax:
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:321-841-3760
Practice Address - Fax:321-841-3232
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012248225100000X
FLPT40073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist