Domanique Ingram

NPI #1205429180 in Longview, Texas

Provider Information

NPI Number: 1205429180
Entity Type: Individual
Name: Domanique Ingram
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Massage Therapist
Enumeration Date: Feb 11, 2021
Last Updated: Feb 11, 2021

Practice Location

Address: 501 N SPUR 63 STE C1
City: Longview
State: Texas
ZIP Code: 75601-5010
Phone: (903) 746-6019

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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