Provider Demographics
NPI:1033767678
Name:BALLINGER, LEXY LEIGH (DOM)
Entity Type:Individual
Prefix:MS
First Name:LEXY
Middle Name:LEIGH
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-4005
Mailing Address - Country:US
Mailing Address - Phone:813-296-2422
Mailing Address - Fax:813-296-2056
Practice Address - Street 1:505 E JACKSON ST STE 211
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4935
Practice Address - Country:US
Practice Address - Phone:813-296-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist