Provider Demographics
NPI:1134117724
Name:BALL, BRIAN LEE (ATC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:BALL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16365 CARAWAY CT
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4757
Mailing Address - Country:US
Mailing Address - Phone:815-588-1516
Mailing Address - Fax:
Practice Address - Street 1:333 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3651
Practice Address - Country:US
Practice Address - Phone:312-674-1000
Practice Address - Fax:312-674-5602
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer