Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | VA |
NPI | 1669025540 |
---|---|
Provider Name | Kathryn Marie Ingraham |
First Address | Mechanicsville, VA 23116-1844 |
Second Address | Mechanicsville, VA 23116-1844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2019 |
Last Update Date | 19/07/2019 |