Provider Demographics
NPI:1023554268
Name:INGSTAD, GOLDIE LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:GOLDIE
Middle Name:LYNN
Last Name:INGSTAD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 COWBOYS PKWY APT 3037
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7739
Mailing Address - Country:US
Mailing Address - Phone:972-409-8653
Mailing Address - Fax:
Practice Address - Street 1:715 COWBOYS PKWY APT 3037
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7739
Practice Address - Country:US
Practice Address - Phone:972-409-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT029147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist