Individual
NICHOLE SHIREE COOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
4411 S ADAMS ST, MARION, IN 46953-5349
(765) 674-4455
(765) 674-3577
Mailing address
4411 S ADAMS ST, MARION, IN 46953-5349
(765) 674-4455
(765) 674-3577
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
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