Individual
MARISSA INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1649 E PINE AVE, MERIDIAN, ID 83642-8135
(208) 917-2660
Mailing address
2127 S LINDA VISTA PL, BOISE, ID 83709-8246
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8076
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT8076
LICENSE
ID
Enumeration date
06/09/2022
Last updated
06/24/2025
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