Provider Demographics
NPI:1033650387
Name:BALLENTINE, BRITTANY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:BALLENTINE
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 1:1034 CAMP GROUND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9439
Mailing Address - Country:US
Mailing Address - Phone:803-609-2582
Mailing Address - Fax:
Practice Address - Street 1:1034 CAMP GROUND RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9439
Practice Address - Country:US
Practice Address - Phone:803-609-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2486225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant