Provider Demographics
NPI:1417675000
Name:SABALLOS, INGRID (LMT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:SABALLOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 HICKORY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-6516
Mailing Address - Country:US
Mailing Address - Phone:504-478-1823
Mailing Address - Fax:
Practice Address - Street 1:1939 HICKORY AVE STE 202
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-6516
Practice Address - Country:US
Practice Address - Phone:504-478-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA5217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist