Provider Demographics
NPI:1558494443
Name:RICK INGRAHAM LLC
Entity Type:Organization
Organization Name:RICK INGRAHAM LLC
Other - Org Name:LLOYD PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-470-9973
Mailing Address - Street 1:4105 MEDICAL PKWY
Mailing Address - Street 2:#100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3725
Mailing Address - Country:US
Mailing Address - Phone:512-458-6386
Mailing Address - Fax:512-458-6388
Practice Address - Street 1:4105 MEDICAL PKWY
Practice Address - Street 2:#100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3725
Practice Address - Country:US
Practice Address - Phone:512-458-6386
Practice Address - Fax:512-458-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy