MEDICARE: DR. CODY MICHAEL BALLAY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT019453	OH

General Provider Information

NPI Number	:	1174216428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY MICHAEL BALLAY PT, DPT

Provider Business Mailing Address
First Line	:	1270 N GRANT AVE APT 210
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-4441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 N HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43081-2062
Country	:	US
Telephone Number	:	614-366-0722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/01/2023

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