Provider Demographics
NPI:1033366042
Name:BALLINGER, JAMIE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 145A
Mailing Address - Street 2:
Mailing Address - City:SIGEL
Mailing Address - State:IL
Mailing Address - Zip Code:62462-9740
Mailing Address - Country:US
Mailing Address - Phone:217-844-3681
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 145A
Practice Address - Street 2:
Practice Address - City:SIGEL
Practice Address - State:IL
Practice Address - Zip Code:62462-9740
Practice Address - Country:US
Practice Address - Phone:217-844-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004355225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant