Basic Information
| Provider Information | |||||||||
| NPI: | 1891735403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INGRAHAM | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 4253389637 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 W STANLEY ST | ||||||||
| Address2: | |||||||||
| City: | GRANITE FALLS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982528631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606914835 | ||||||||
| FaxNumber: | 3606912545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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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 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8336463 | 05 | WA | MEDICAID | 911745305-98252-B003 | 01 | WA | TRICARE | OTHER | 0128226 | 01 | WA | LABOR & INDUSTRY | OTHER | 7491IN | 01 | WA | REGENCE BLUE SHIELD | OTHER | 5085695 | 01 | WA | AETNA | OTHER | Q4WYR1 | 01 | WA | EMPIRE BC,BS | OTHER | 8928858 | 01 | WA | L&I CRIME VICTIMS | OTHER |