Provider Demographics
NPI:1033357017
Name:BALLINGER, JEANNE BROUSSARD (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:BROUSSARD
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5555 N LAMAR BLVD
Mailing Address - Street 2:STE L 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1073
Mailing Address - Country:US
Mailing Address - Phone:512-200-2332
Mailing Address - Fax:512-852-4557
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:STE L 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1073
Practice Address - Country:US
Practice Address - Phone:512-200-2332
Practice Address - Fax:512-852-4557
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11118702251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology