Provider Demographics
NPI:1801075353
Name:INGRAM, ANGELA (PT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:INGRAM
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:PO BOX 273
Mailing Address - Street 2:8745 BLACKBIRD LANE
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-0273
Mailing Address - Country:US
Mailing Address - Phone:740-246-5483
Mailing Address - Fax:
Practice Address - Street 1:8745 BLACKBIRD LN
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-9515
Practice Address - Country:US
Practice Address - Phone:740-246-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist