Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1151099 | TX |
NPI | 1568130326 |
---|---|
Provider Name | Ann Ballweg |
First Address | Fort Worth, TX 76109-4148 |
Second Address | Fort Worth, TX 76109-4148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2021 |
Last Update Date | 05/09/2021 |