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NPI Code Detail

MEDICARE: MR. PATRICK JOSEPH BALLINGER SR. ATC, LAT

MEDICARE:  MR. PATRICK JOSEPH BALLINGER SR. ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225500000XRespiratory/Developmental/Rehabilitative Specialist/Technologist0506005NV

General Provider Information

NPI Number : 1093788259
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PATRICK JOSEPH BALLINGER SR. ATC, LAT
Provider Business Mailing Address
First Line : 458 PAULSON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-0161
Country : US
Telephone Number : 702-896-4520
Fax Number :
Provider Business Practice Location Address
First Line : 3131 LAS VEGAS BLVD S
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-1967
Country : US
Telephone Number : 702-770-3752
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 07/08/2007

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Directions to “ MR. PATRICK JOSEPH BALLINGER SR. ATC, LAT” Practice Location

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