Provider Demographics
NPI:1063689479
Name:INGLIN, ADAM P (LMP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:P
Last Name:INGLIN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ERIE ST SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4083
Mailing Address - Country:US
Mailing Address - Phone:360-943-2285
Mailing Address - Fax:360-943-3085
Practice Address - Street 1:204 ERIE ST SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4083
Practice Address - Country:US
Practice Address - Phone:360-943-2285
Practice Address - Fax:360-943-3085
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015201225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist