MEDICARE: LAURA JUNE BALLARD DPT

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
1	225100000X	Physical Therapist	13975	NC

General Provider Information

NPI Number	:	1851637540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JUNE BALLARD DPT

Provider Business Mailing Address
First Line	:	PO BOX 12909
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28561-2909
Country	:	US
Telephone Number	:	252-636-9800
Fax Number	:	252-636-1945

Provider Business Practice Location Address
First Line	:	2752 RICHLANDS HWY
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-3611
Country	:	US
Telephone Number	:	910-938-7555
Fax Number	:	910-938-7544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2012
Last Update Date	:	12/27/2012

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