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General NPI Number Information
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NPI Number | 1295433126
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Entity Type | Organization
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Legal Business Name | LEGEND PHYSICAL THERAPY OF BALLINGER, LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 408 HUTCHINS AVE
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City | BALLINGER
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State | TX
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Zip | 76821
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Country | US
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Telephone | 325-234-6733
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Fax |
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Provider Business Mailing Address
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Address Line | 15701 US HIGHWAY 67
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City | MILES
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State | TX
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Zip | 76861-6700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | JOHANNA M LANGE
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Credential | PT, DPT
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Telephone | 325-234-6733
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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 |
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License Number State |
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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 |
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License Number State |
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