Healthcare Provider Details

I. General information

NPI: 1679984355
Provider Name (Legal Business Name): REBECCA BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 E ASBURY AVE #1312
DENVER CO
80210
US

IV. Provider business mailing address

235 BRENTWOOD ST
LAKEWOOD CO
80226-1346
US

V. Phone/Fax

Practice location:
  • Phone: 303-871-2567
  • Fax:
Mailing address:
  • Phone: 303-871-2567
  • Fax: 303-871-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: