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General NPI Number Information
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NPI Number | 1013889872
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Entity Type | Individual
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Provider Name | KAITLYN FAITH BALLARD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 301 W 26TH ST
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4713
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Country | US
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Telephone | 850-769-5371
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Fax |
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Provider Business Mailing Address
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Address Line | 220 SEA SOUND CIR APT 2107
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2637
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Country | US
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Telephone | 937-336-9446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 34346
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License Number State | FL
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