Healthcare Provider Details

I. General information

NPI: 1326690678
Provider Name (Legal Business Name): JOSEPH BALLENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 FALL RIVER DR
LOVELAND CO
80538-7157
US

IV. Provider business mailing address

5387 MANHATTAN CIR
BOULDER CO
80303-4284
US

V. Phone/Fax

Practice location:
  • Phone: 970-775-8626
  • Fax:
Mailing address:
  • Phone: 303-494-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPA.0006891
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPA.0006891
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0006891
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: