Healthcare Provider Details

I. General information

NPI: 1023892676
Provider Name (Legal Business Name): AMBER LEIGH BALLARD LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7502 FONDREN RD
HOUSTON TX
77074-3204
US

IV. Provider business mailing address

7145 READING RD APT 607
ROSENBERG TX
77471-6327
US

V. Phone/Fax

Practice location:
  • Phone: 214-490-5427
  • Fax:
Mailing address:
  • Phone: 214-490-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: