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General NPI Number Information
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NPI Number | 1396896205
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Entity Type | Individual
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Provider Name | ERIC AARON INGOLD DPT
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 209 ELDEN ST SUITE 106
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City | HERNDON
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State | VA
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Zip | 20170-4852
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Country | US
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Telephone | 703-481-3551
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Fax | 703-481-3276
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Provider Business Mailing Address
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Address Line | 16545 GOLDENCREST CIR SUITE 106
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City | PURCELLVILLE
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State | VA
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Zip | 20132-9654
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Country | US
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Telephone | 571-858-9398
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Fax | 571-858-9398
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305202442
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License Number State | VA
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