Ballard, Blake A.

Ballard, Blake A. is an individual health care provider with primary practice located at 314 Main St Ste C , Monticello MS 39654-3702. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as his primary health care specialty. Ballard, Blake A. can be contacted via phone (601) 587-2563.

Contact Information

Primary practice address
314 Main St Ste C Monticello MS 39654-3702
Phone: (601) 587-2563
Fax: (601) 587-0472
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X PTA6757 Mississippi

Profile Details

NPI number 1487255535
LBN Legal business name Ballard, Blake A.
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 5th, 2020
Last updated Nov 5th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487255535 NPPES
Mississippi Other PTA6757 MS STATE BOARD OF PHYSICAL THERAPY

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