Healthcare Provider Details

I. General information

NPI: 1831607019
Provider Name (Legal Business Name): JOEL INGRAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 8TH AVE W
CRESCO IA
52136-1062
US

IV. Provider business mailing address

850 43RD AVE STE 100
MOLINE IL
61265-8401
US

V. Phone/Fax

Practice location:
  • Phone: 563-547-6361
  • Fax:
Mailing address:
  • Phone: 309-743-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: