Provider Demographics
NPI:1740626274
Name:INGRAM, ERIC LEE (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:INGRAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3660
Mailing Address - Country:US
Mailing Address - Phone:318-518-8911
Mailing Address - Fax:
Practice Address - Street 1:1135 EXPRESSWAY DR
Practice Address - Street 2:SUITE 100 B
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6653
Practice Address - Country:US
Practice Address - Phone:318-487-6525
Practice Address - Fax:318-487-6527
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist