Provider Demographics
NPI:1780652388
Name:GRUTZMACHER, INGRID MARY (ATC)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:MARY
Last Name:GRUTZMACHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 FAIRWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7840
Mailing Address - Country:US
Mailing Address - Phone:770-528-0251
Mailing Address - Fax:
Practice Address - Street 1:5718 FAIRWOOD DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7840
Practice Address - Country:US
Practice Address - Phone:770-528-0251
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer