Provider Demographics
NPI:1316055437
Name:INGHAM, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:INGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 HILLSIDE RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7196
Mailing Address - Country:US
Mailing Address - Phone:806-355-7633
Mailing Address - Fax:
Practice Address - Street 1:6204 HILLSIDE RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7196
Practice Address - Country:US
Practice Address - Phone:806-355-7633
Practice Address - Fax:806-355-7644
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1020972OtherLICENSE#