Nichole Shiree Coomer, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05008703A Issued in IN

Practice address

4411 S Adams St
Marion, IN 46953-5349

Phone

(765) 674-4455

Fax

(765) 674-3577

NPI assigned

Mar 24, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Physical Therapy, Occupational Therapy and Speech Language PAGroup PAC ID 7012997638, 385 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path

  • Physical Therapist
  • Peru, IN
  • NPI 1750764494
  Medicare reassignment Care Compare group NPD
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
  • NPI 1215637699
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1285751149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 S ADAMS ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469535349",
            "telephone_number": "765-674-4455",
            "fax_number": "765-674-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 S ADAMS ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469535349",
            "telephone_number": "765-674-4455",
            "fax_number": "765-674-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOMER",
        "first_name": "NICHOLE",
        "middle_name": "SHIREE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-24",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05008703A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000385497",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "05008703A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Daniel Conrad, NP
• Katlyn Converse
• Lindsey Leeana Cook, FNP-C
• Madison Cook
• Sarah Cook
• Joel R Cooper Jr.
• Bethany Dawn Coppock, COTA
• Kayla Corey
• Alyssa Corn
• Izabel Cornejo, RBT

• Physical Therapist in Marion, IN
• Providers in Marion, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.