Individual
NICHOLE SHIREE COOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008703A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000385497
ANTHEM PROVIDER NUMBER
IN
01
—
05008703A
PHYSICAL THERAPY LICENSE
IN
Enumeration date
03/24/2007
Last updated
09/08/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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