Jeffrey Coleman, MPT

Individual provider Active NPI Specialist · Ronceverte, WV

NPI 1508945130 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1508945130
Entity type
Individual (NPI type 1)
Primary specialty
Specialist 174400000X
Practice address
111 Davis Stuart Road
Ronceverte, WV 24970
Phone
(304) 647-3987
Fax
(304) 647-3990
NPI assigned
Nov 3, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Yes

Addresses

Primary practice location

111 Davis Stuart Road
Ronceverte, WV 24970

Mailing address

111 Davis Stuart Road
Ronceverte, WV 24970
Phone (304) 647-3987

Other identifiers

IdentifierTypeStateIssuer
3810004658MedicaidWV

Other providers in Ronceverte, WV

All providers in Ronceverte, WV · Specialist in West Virginia

Sources for this page

Verify at the official NPI Registry.