Healthcare Provider Details

I. General information

NPI: 1992316186
Provider Name (Legal Business Name): NICOLETTE RAE INGEL PHYSICAL THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8TH MEDICAL GROUP UNIT 2022
APO AP
96264-2022
US

IV. Provider business mailing address

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND TX
78236-5638
US

V. Phone/Fax

Practice location:
  • Phone: 412-992-8842
  • Fax:
Mailing address:
  • Phone: 210-292-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20105
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT005450
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT028694
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: