Active NPI
Domanique Ingram
- Massage Therapist
- Longview, TX
National Provider Identifier
1205429180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT123998
- Practice address
- 501 N Spur 63 Ste C1
Longview, TX 75601-5010 - Phone
- (903) 746-6019
- NPI assigned
- Feb 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT123998 | TX | Primary |
Addresses
Primary practice location
501 N Spur 63 Ste C1
Longview, TX 75601-5010
Mailing address
1203 W River Oaks Dr
Longview, TX 75604-5844
Phone (903) 746-6019
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT123998 | TX | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613001600000",
"number": "1205429180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 W RIVER OAKS DR",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756045844",
"telephone_number": "903-746-6019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 N SPUR 63 STE C1",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756015010",
"telephone_number": "903-746-6019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "DOMANIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-11",
"last_updated": "2021-02-11",
"certification_date": "2021-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT123998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.