Healthcare Provider Details

I. General information

NPI: 1326047267
Provider Name (Legal Business Name): MICHAEL BALL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9929 SW BANK RD STE 101
VASHON WA
98070-5014
US

IV. Provider business mailing address

13104 SW 220TH ST
VASHON WA
98070-6334
US

V. Phone/Fax

Practice location:
  • Phone: 206-567-7740
  • Fax: 206-567-7741
Mailing address:
  • Phone: 206-567-7740
  • Fax: 206-567-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18175
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60117577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: