MEDICARE: LISA INGRAM LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	397	AL

General Provider Information

NPI Number	:	1326144122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA INGRAM LPTA

Provider Business Mailing Address
First Line	:	1837 PLEASANT RIDGE DR
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-1761
Country	:	US
Telephone Number	:	256-249-3594
Fax Number	:

Provider Business Practice Location Address
First Line	:	727 STONE AVE
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160-2218
Country	:	US
Telephone Number	:	256-362-9477
Fax Number	:	256-362-9255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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