Provider Demographics
NPI:1609480680
Name:INGMANSON, ALYSSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:INGMANSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SUN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-8909
Mailing Address - Country:US
Mailing Address - Phone:203-615-2527
Mailing Address - Fax:
Practice Address - Street 1:999 SUMMER ST STE 104
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5513
Practice Address - Country:US
Practice Address - Phone:203-504-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist