Provider Demographics
NPI:1235431396
Name:ANDERSON, INGRID (DPT, PT, OCS)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT, PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 MORELAND AVE SE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1552
Mailing Address - Country:US
Mailing Address - Phone:404-883-2304
Mailing Address - Fax:404-393-3270
Practice Address - Street 1:495 MORELAND AVE SE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1552
Practice Address - Country:US
Practice Address - Phone:404-883-2304
Practice Address - Fax:404-393-3270
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist