Provider Demographics
NPI:1942702493
Name:INGALLA, JOEBELLE DELA CRUZ (RPT)
Entity Type:Individual
Prefix:
First Name:JOEBELLE
Middle Name:DELA CRUZ
Last Name:INGALLA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:INGALLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:MIDMICHIGAN MEDICAL CENTER 4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670
Mailing Address - Country:US
Mailing Address - Phone:989-839-3529
Mailing Address - Fax:989-839-3880
Practice Address - Street 1:4000 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670
Practice Address - Country:US
Practice Address - Phone:989-839-3529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist