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NPI Code Detail

MEDICARE: MR. BRUCE SPENCER BALLARD PT

MEDICARE: MR. BRUCE SPENCER BALLARD 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 TherapistPT2771MS

General Provider Information

NPI Number : 1700934346
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE SPENCER BALLARD PT
Provider Business Mailing Address
First Line : 1202 HARRISON ST
Second Line :
City : TUPELO
State : MS
Zip : 38801-5646
Country : US
Telephone Number : 662-680-9416
Fax Number : 662-862-4970
Provider Business Practice Location Address
First Line : 711 AVIGNON DR
Second Line :
City : RIDGELAND
State : MS
Zip : 39157-5120
Country : US
Telephone Number : 601-605-6777
Fax Number : 601-605-8869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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Directions to “ MR. BRUCE SPENCER BALLARD PT” Practice Location

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