Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1111870 | TX |
NPI | 1033357017 |
---|---|
Provider Name | Mrs. Jeanne Broussard Ballinger |
First Address | Austin, TX 78751-1073 |
Second Address | Austin, TX 78751-1073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 10/01/2013 |