Healthcare Provider Details

I. General information

NPI: 1326951898
Provider Name (Legal Business Name): ADRIENNE INGALLA PT, DPT, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 17TH ST STE C9
COSTA MESA CA
92627-4343
US

IV. Provider business mailing address

3624 GLENWOOD AVE
GLENDALE CA
91208-1015
US

V. Phone/Fax

Practice location:
  • Phone: 949-529-1567
  • Fax:
Mailing address:
  • Phone: 818-731-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT295964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: