Active NPI
Nicole Booms
- Physical Therapist
- Livonia, MI
National Provider Identifier
1851921423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 17197 N Laurel Park Dr Ste 555
Livonia, MI 48152-2686 - Phone
- (734) 779-9700
- NPI assigned
- Jan 22, 2020
- Last updated
- Jan 22, 2020
- 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 | NU | Primary |
Addresses
Primary practice location
17197 N Laurel Park Dr Ste 555
Livonia, MI 48152-2686
Mailing address
1618 Treeside Dr
Rochester Hills, MI 48307-3474
Phone (248) 842-5298
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jliedel@medteam.com |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1851921423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1618 TREESIDE DR",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483073474",
"telephone_number": "248-842-5298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17197 N LAUREL PARK DR STE 555",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481522686",
"telephone_number": "734-779-9700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOMS",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-22",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jliedel@medteam.com",
"affiliation": "N",
"address_1": "17197 N Laurel Park Dr Ste 555",
"city": "Livonia",
"state": "MI",
"country_code": "US",
"postal_code": "481522686",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.