Individual
MALCOLM LEWIS INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
8855 GALLERY ST, LENEXA, KS 66215-3285
(913) 549-3084
Mailing address
8855 GALLERY ST, LENEXA, KS 66215-3285
(913) 549-3084
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1401738
KS
225200000X
Physical Therapy Assistant
Primary
2005014828
MO
Other
Enumeration date
07/09/2010
Last updated
07/09/2010
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