Healthcare Provider Details

I. General information

NPI: 1548751191
Provider Name (Legal Business Name): AMY ALISHA BALLARD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4687 BOYLSTON HWY
MILLS RIVER NC
28759-6731
US

IV. Provider business mailing address

60 SHUFORD RD
COLUMBUS NC
28722-7406
US

V. Phone/Fax

Practice location:
  • Phone: 828-890-0040
  • Fax: 828-890-0530
Mailing address:
  • Phone: 828-894-0277
  • Fax: 828-894-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22934
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: