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General NPI Number Information
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NPI Number | 1891674628
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Entity Type | Individual
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Provider Name | CULLEN BALLARD
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Gender | Male
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 4150 NELSON RD STE 1
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4148
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Country | US
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Telephone | 337-660-2996
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Fax |
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Provider Business Mailing Address
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Address Line | 1322 ELTON RD STE I
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City | JENNINGS
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State | LA
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Zip | 70546-4100
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Country | US
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Telephone | 337-824-5488
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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 | 12200
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License Number State | LA
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