Healthcare Provider Details

I. General information

NPI: 1487113031
Provider Name (Legal Business Name): KAITLIN INGRAM SNYDER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN ASHLEY INGRAM

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PEAR ORCHARD RD
RIDGELAND MS
39157-4221
US

IV. Provider business mailing address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

V. Phone/Fax

Practice location:
  • Phone: 601-856-2205
  • Fax:
Mailing address:
  • Phone: 601-605-6777
  • Fax: 601-607-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5542
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: