=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831398619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN M INGRAM DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3259 CATLIN AVE
-----------------------------------------------------
City | QUANTICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22134-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-784-1715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4058 LEA MEADOW CT
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22193-5701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-942-0998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305204844
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------