Provider Demographics
NPI:1124470349
Name:COLEMAN, CRAIG COROME (MA)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:COROME
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 S DASH POINT RD
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3733
Mailing Address - Country:US
Mailing Address - Phone:425-269-9560
Mailing Address - Fax:
Practice Address - Street 1:503 12TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5103
Practice Address - Country:US
Practice Address - Phone:206-288-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60499234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist