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General NPI Number Information
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NPI Number | 1699115923
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Entity Type | Individual
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Provider Name | WENDY BALLASCH LMT
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Gender | Female
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 184 BROOKS ST SE UNIT 1
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-2822
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Country | US
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Telephone | 850-543-4756
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Fax | 850-855-9812
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Provider Business Mailing Address
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Address Line | 118 BERGER PL NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5102
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Country | US
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Telephone | 850-543-4756
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Fax | 850-855-9812
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA31025
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License Number State | FL
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