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NPI Code Detail

MEDICARE: PAMELA BALLA-DIBBLEE PT

MEDICARE: PAMELA BALLA-DIBBLEE PT
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
1225100000XPhysical Therapist308035-2401UT

General Provider Information

NPI Number : 1700934098
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA BALLA-DIBBLEE PT
Provider Business Mailing Address
First Line : PO BOX 25537
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84125-0537
Country : US
Telephone Number : 801-253-5970
Fax Number :
Provider Business Practice Location Address
First Line : 12473 S MINUTEMAN DR
Second Line :
City : DRAPER
State : UT
Zip : 84020-7870
Country : US
Telephone Number : 801-495-7950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 04/15/2026

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Directions to “ PAMELA BALLA-DIBBLEE PT” Practice Location

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