Provider Demographics
NPI:1790716728
Name:IGHARAS, JOSEPHINE LEDDA (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:LEDDA
Last Name:IGHARAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 CALLA DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-8102
Mailing Address - Country:US
Mailing Address - Phone:901-380-5668
Mailing Address - Fax:901-820-7431
Practice Address - Street 1:2986 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4003
Practice Address - Country:US
Practice Address - Phone:901-820-7430
Practice Address - Fax:901-820-7431
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36469592Medicare PIN