Individual
JODIE INGRHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32 HAMPTON VILLAGE PLZ, SAINT LOUIS, MO 63109-2127
(314) 353-2626
Mailing address
8430 BIG BEND BLVD, SAINT LOUIS, MO 63119-3116
(314) 963-1343
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002008836
LICENSE#
MO
Enumeration date
08/28/2006
Last updated
07/08/2007
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