Provider Demographics
NPI:1083427710
Name:COLEMAN, LAQUANDRA
Entity type:Individual
Prefix:
First Name:LAQUANDRA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S BROADWAY ST APT 3145
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-0050
Mailing Address - Country:US
Mailing Address - Phone:601-325-1248
Mailing Address - Fax:
Practice Address - Street 1:2540 MARSH LN STE 124
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2185
Practice Address - Country:US
Practice Address - Phone:601-325-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier