Provider Demographics
NPI:1023689254
Name:COLEMAN, EMILY MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W OLYMPIC BLVD APT 1631
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1470
Mailing Address - Country:US
Mailing Address - Phone:914-563-4099
Mailing Address - Fax:
Practice Address - Street 1:4515 OCEAN VIEW BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-1409
Practice Address - Country:US
Practice Address - Phone:818-368-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic