Provider Demographics
NPI:1801076104
Name:BIRD, INGRED MARGARITA (PTA)
Entity type:Individual
Prefix:MRS
First Name:INGRED
Middle Name:MARGARITA
Last Name:BIRD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 S ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4852
Mailing Address - Country:US
Mailing Address - Phone:407-539-1792
Mailing Address - Fax:497-539-2228
Practice Address - Street 1:1155 S ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4852
Practice Address - Country:US
Practice Address - Phone:407-539-1792
Practice Address - Fax:497-539-2228
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19338225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant