Active NPI
Kathy J Boehm, P.T.
- Physical Therapist
- Warren, MI
National Provider Identifier
1245441195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501002202
- Practice address
- 27450 Schoenherr
100
Warren, MI 48088 - Phone
- (586) 582-7825
- Fax
- (586) 582-7826
- NPI assigned
- May 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501002202 | MI | Primary |
Addresses
Primary practice location
27450 Schoenherr
100
Warren, MI 48088
Mailing address
5271 Vineyards Blvd
Sterling Heights, MI 48314
Phone (586) 323-1153
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5171931 | Medicaid | MI |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501002202 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245441195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5271 VINEYARDS BLVD",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "48314",
"telephone_number": "586-323-1153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27450 SCHOENHERR",
"address_2": "100",
"city": "WARREN",
"state": "MI",
"postal_code": "48088",
"telephone_number": "586-582-7825",
"fax_number": "586-582-7826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOEHM",
"first_name": "KATHY",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501002202",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5171931",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.