Healthcare Provider Details

I. General information

NPI: 1558494443
Provider Name (Legal Business Name): RICK INGRAHAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 MEDICAL PKWY #100
AUSTIN TX
78756-3725
US

IV. Provider business mailing address

4105 MEDICAL PKWY #100
AUSTIN TX
78756-3725
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-6386
  • Fax: 512-458-6388
Mailing address:
  • Phone: 512-458-6386
  • Fax: 512-458-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK INGRAHAM
Title or Position: OWNER
Credential:
Phone: 512-470-9973