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General NPI Number Information
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NPI Number | 1144748534
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Entity Type | Individual
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Provider Name | KAITLYN BALLESTEROS DPT
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Gender | Female
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 3280 URBANA PIKE STE 202
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City | IJAMSVILLE
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State | MD
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Zip | 21754-9406
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Country | US
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Telephone | 301-874-2226
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Fax | 301-874-5955
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Provider Business Mailing Address
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Address Line | 8910 PURDUE RD STE 700
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-6136
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Country | US
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Telephone | 317-884-3383
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Fax | 410-648-4878
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27045
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT872161
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License Number State | DC
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