Provider Demographics
NPI:1164855888
Name:INGRAHAM, GRACE L
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:L
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BRIMFIELD DR
Mailing Address - Street 2:APT A8
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6972
Mailing Address - Country:US
Mailing Address - Phone:913-800-0341
Mailing Address - Fax:
Practice Address - Street 1:1300 BRIMFIELD DR
Practice Address - Street 2:APT A8
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6972
Practice Address - Country:US
Practice Address - Phone:913-800-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant