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General NPI Number Information
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NPI Number | 1154763431
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Entity Type | Individual
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Provider Name | ANNA M BALLARD P.T.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 6290 JUPITER AVE NE STE C
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City | BELMONT
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State | MI
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Zip | 49306-8885
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Country | US
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Telephone | 616-364-3290
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Fax | 616-364-3299
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Provider Business Mailing Address
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Address Line | 5060 CASCADE RD SE STE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3808
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Country | US
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Telephone | 616-364-3290
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Fax | 616-364-3299
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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 | 5502003920
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License Number State | MI
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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 | 5501019881
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License Number State | MI
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