Healthcare Provider Details

I. General information

NPI: 1265644124
Provider Name (Legal Business Name): LYDIA G BALLARD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PARK DR
WESTFORD MA
01886-3511
US

IV. Provider business mailing address

65 LAKE SHORE DR S
WESTFORD MA
01886-1628
US

V. Phone/Fax

Practice location:
  • Phone: 978-392-1144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3653
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0296
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: