Individual
LORA INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1054 GARDENIA RD, VIRGINIA BEACH, VA 23452-6002
(757) 461-5001
Mailing address
1054 GARDENIA RD, VIRGINIA BEACH, VA 23452-6002
(757) 461-5001
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306001316
VA
Other
Enumeration date
02/15/2012
Last updated
02/15/2012
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