| Doctor Name: | STACEY INGRAM |
| NPI Number: | 1942639737 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PT20309 |
| Business Practice Address: | 34990 Us Hwy 19 North Palm Harbor, FL - 34684 |
| Business Phone Number: | 7272100760 |
| Business Fax Number: | |
| Mailing Address: | 34990 Us Highway 19 N, PALM HARBOR |
| State: | FL |
| Postal Code: | 346841920 |
| Phone Number: | 7272100760 |
| Fax Number: | 7272100761 |
| NPI Enumeration Date: | 11/02/2013 |
| NPI Last Update Date: | 11/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT20309 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |