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NPI Code Detail

MEDICARE: MS. URSULA YVONNE BOOTH P.T.

MEDICARE: MS. URSULA YVONNE BOOTH P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist05004557AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000525491OTHERINANTHEM/BCBS PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31235335985OTHERINGROUP NPI
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
511758517OTHERINCAQH

General Provider Information

NPI Number : 1962607879
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. URSULA YVONNE BOOTH P.T.
Provider Business Mailing Address
First Line : 33900 HARPER AVE
Second Line : SUITE 104
City : CLINTON TOWNSHIP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-416-9100
Fax Number : 586-416-9103
Provider Business Practice Location Address
First Line : 8628 PURDUE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1114
Country : US
Telephone Number : 317-677-0660
Fax Number : 317-677-0640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2007
Last Update Date : 08/04/2016

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