Healthcare Provider Details

I. General information

NPI: 1174216428
Provider Name (Legal Business Name): CODY MICHAEL BALLAY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 N HAMILTON RD
COLUMBUS OH
43081-2062
US

IV. Provider business mailing address

1270 N GRANT AVE APT 210
COLUMBUS OH
43201-4441
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-0722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT019453
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: