Provider Demographics
NPI:1053768465
Name:COLEMAN, BRIAN (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 BOONES FERRY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3455
Mailing Address - Country:US
Mailing Address - Phone:503-454-6236
Mailing Address - Fax:
Practice Address - Street 1:15630 BOONES FERRY RD STE 6
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3455
Practice Address - Country:US
Practice Address - Phone:503-454-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60465913225100000X
OR61673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist