Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 9362 | TN |
Y | 225100000X | Physical Therapist | PTH9450 | AL |
NPI | 1003161167 |
---|---|
Provider Name | Elizabeth Anne Ballard |
First Address | Rome, GA 30162-0949 |
Second Address | Ozark, AL 36360-3712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 06/09/2019 |