Provider Demographics
NPI:1154937837
Name:COLEMAN, ANDRENIQUE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ANDRENIQUE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HARDIN BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-1987
Mailing Address - Country:US
Mailing Address - Phone:317-518-0239
Mailing Address - Fax:
Practice Address - Street 1:815 HARDIN BLVD APT C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-1987
Practice Address - Country:US
Practice Address - Phone:317-518-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist