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General NPI Number Information
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NPI Number | 1073955431
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Entity Type | Individual
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Provider Name | WILLIAM JAMES INGERLY PTA
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 379 W WESTERN AVE STE 101
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City | MUSKEGON
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State | MI
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Zip | 49440-1265
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Country | US
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Telephone | 231-845-1906
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Fax | 231-903-4064
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Provider Business Mailing Address
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Address Line | PO BOX 412031
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City | BOSTON
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State | MA
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Zip | 02241-2031
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Country | US
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Telephone | 914-294-4050
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Fax | 631-760-8306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | L2259117
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501019023
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License Number State | MI
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