Basic Information
| Provider Information | |||||||||
| NPI: | 1366588022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAROUCHE | ||||||||
| FirstName: | INGRID | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 964 | ||||||||
| Address2: | |||||||||
| City: | BINGEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986051664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095219621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 729 HENDERSON ROAD | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413862688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8501 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 5027 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.