Individual ProviderNicole Eileen BoothePhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address751 S Bascom Ave, San Jose, CA 95128-2604(408) 885-5000(650) 743-5247PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Eileen Boothe does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1619486305Provider TypeIndividualFull NameBoothe, Nicole EileenCredentialDPTGenderFemaleSole ProprietorNoEnumeration Date9/25/2017Last Updated9/25/2017Contact InformationPractice LocationPractice Address751 S Bascom Ave, San Jose, CA 95128-2604Phone(408) 885-5000FaxUnlisted FaxMailing LocationMailing Address420 Sycamore St, San Carlos, CA 94070-2018Phone(650) 743-5247FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense293297California