Provider Demographics
NPI:1942440813
Name:LADAGA-PANIAMOGAN RPT, INGRID TORRALBA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:TORRALBA
Last Name:LADAGA-PANIAMOGAN RPT
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12023 FIR ST
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64442-8180
Mailing Address - Country:US
Mailing Address - Phone:660-425-2211
Mailing Address - Fax:660-425-7919
Practice Address - Street 1:12023 FIR ST
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64442-8180
Practice Address - Country:US
Practice Address - Phone:660-867-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005035775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist