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General NPI Number Information
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NPI Number | 1679255822
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Entity Type | Individual
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Provider Name | KRISTIAN WESLEY BALE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 4583 GUTHRIE HWY
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City | CLARKSVILLE
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State | TN
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Zip | 37040-5422
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Country | US
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Telephone | 931-802-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 844 BURLEY BARN RD
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City | CLARKSVILLE
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State | TN
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Zip | 37042-2107
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Country | US
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Telephone | 931-358-8533
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16064
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License Number State | TN
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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 | 05015290A
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License Number State | IN
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