Provider Demographics
NPI:1366772642
Name:INGELL, SCOTT (LMT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:INGELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 21221
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424
Mailing Address - Country:US
Mailing Address - Phone:423-855-4888
Mailing Address - Fax:
Practice Address - Street 1:6251 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3913
Practice Address - Country:US
Practice Address - Phone:423-855-4888
Practice Address - Fax:423-305-1752
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TN613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker