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General NPI Number Information
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NPI Number | 1972513901
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Entity Type | Individual
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Provider Name | CAROLYN A INGRAHAM PT
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4923 US ROUTE 5 SOJOURNS COMMUNITY HEALTH CLINIC
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City | WESTMINSTER
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State | VT
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Zip | 05158
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Country | US
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Telephone | 802-722-4023
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Fax | 802-722-4137
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Provider Business Mailing Address
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Address Line | 4923 US ROUTE 5
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City | WESTMINSTER
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State | VT
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Zip | 05158
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Country | US
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Telephone | 802-722-4023
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Fax | 802-722-4137
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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 | 0400003171
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License Number State | VT
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