Active NPI
Nicole Elizabeth Herrle, PT
- Physical Therapist
- Gypsum, CO
National Provider Identifier
1154837516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTL.0010938
- Practice address
- 0130 Summer Meadow St
Gypsum, CO 81637-0424 - Phone
- (970) 690-9579
- NPI assigned
- Dec 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | PTL.0010938 | CO | |
| Physical Therapist | 225100000X | PTL.0010938 | CO | Primary |
Addresses
Primary practice location
0130 Summer Meadow St
Gypsum, CO 81637-0424
Mailing address
PO Box 424
Gypsum, CO 81637-0424
Phone (970) 690-9579
Other names 1
- Nicole Elizabeth Bouska
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL.0010938 | CO | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513814400000",
"number": "1154837516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 424",
"city": "GYPSUM",
"state": "CO",
"postal_code": "816370424",
"telephone_number": "970-690-9579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "0130 SUMMER MEADOW ST",
"city": "GYPSUM",
"state": "CO",
"postal_code": "816370424",
"telephone_number": "970-690-9579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRLE",
"first_name": "NICOLE",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-21",
"last_updated": "2017-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CO",
"license": "PTL.0010938",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "PTL.0010938",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "BOUSKA",
"middle_name": "ELIZABETH",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Gypsum, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.