Provider Demographics
NPI:1891735403
Name:INGRAHAM, ROBIN A (PT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:403 W STANLEY ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8631
Practice Address - Country:US
Practice Address - Phone:360-691-4835
Practice Address - Fax:360-691-2545
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8336463Medicaid
WA911745305-98252-B003OtherTRICARE
WA0128226OtherLABOR & INDUSTRY
WA7491INOtherREGENCE BLUE SHIELD
WA5085695OtherAETNA
WAQ4WYR1OtherEMPIRE BC,BS
WA8928858OtherL&I CRIME VICTIMS
WAQ4WYR1OtherEMPIRE BC,BS