Provider Demographics
NPI:1053000851
Name:COLEMAN, SARA G (LMT #8705)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:G
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMT #8705
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 AVONDALE LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4265
Mailing Address - Country:US
Mailing Address - Phone:318-286-0155
Mailing Address - Fax:
Practice Address - Street 1:4330 PANTHER DR STE 206
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4234
Practice Address - Country:US
Practice Address - Phone:318-286-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8705225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist