Provider Demographics
NPI:1164016283
Name:BALLA, NATALA
Entity Type:Individual
Prefix:
First Name:NATALA
Middle Name:
Last Name:BALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 BRISTOL PIKE STE 203
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5679
Mailing Address - Country:US
Mailing Address - Phone:215-633-9080
Mailing Address - Fax:215-633-9915
Practice Address - Street 1:1338 BRISTOL PIKE STE 203
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5679
Practice Address - Country:US
Practice Address - Phone:215-633-9080
Practice Address - Fax:215-633-9915
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA028511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist