Basic Information
| Provider Information | |||||||||
| NPI: | 1275903361 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | SEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 PACIFIC COAST HWY | ||||||||
| Address2: | # A2 | ||||||||
| City: | SEAL BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907406214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 9475 ROOSEVELT BLVD | ||||||||
| Address2: | B4 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191142212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154646200 | ||||||||
| FaxNumber: | 2154649834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2015 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT024602 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.