Active NPI
Heidi Boothby
- Physical Therapist
- Roseville, MI
National Provider Identifier
1265734479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501013901
- Practice address
- 18285 E 10 Mile Rd
Ste 100
Roseville, MI 48066-5802 - Phone
- (586) 774-5774
- Fax
- (586) 774-5884
- NPI assigned
- Nov 19, 2010
- Last updated
- Nov 19, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501013901 | MI | Primary |
Addresses
Primary practice location
18285 E 10 Mile Rd
Ste 100
Roseville, MI 48066-5802
Mailing address
34751 Kimberly Dr
Apt. F16
Sterling Heights, MI 48312-5090
Phone (586) 774-5774
Other names 1
- Heidi Jahn
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 |
|---|---|---|---|
| 5501013901 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HC Rehab Solutions LLC | Physical Therapist | Past | Accepting new patients |
| Anesthesia Associates of Ann Arbor, PLLC | Past | Accepting new patients | |
| In Home Rehab,LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Anesthesiology Physician
- Westland, MI
- NPI 1669581997
-
- Physical Therapist
- Roseville, MI
- NPI 1942248422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290124800000",
"number": "1265734479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34751 KIMBERLY DR",
"address_2": "APT. F16",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "483125090",
"telephone_number": "586-774-5774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18285 E 10 MILE RD",
"address_2": "STE 100",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480665802",
"telephone_number": "586-774-5774",
"fax_number": "586-774-5884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTHBY",
"first_name": "HEIDI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-19",
"last_updated": "2010-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501013901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HEIDI",
"last_name": "JAHN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Roseville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.