Provider Demographics
NPI:1144420563
Name:LINGLE, DARLA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:J
Last Name:LINGLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DARLA
Other - Middle Name:J
Other - Last Name:CUMMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-9583
Mailing Address - Country:US
Mailing Address - Phone:574-862-2936
Mailing Address - Fax:
Practice Address - Street 1:3630 HICKORY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8865
Practice Address - Country:US
Practice Address - Phone:574-252-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005273A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200728130Medicaid