Provider Demographics
NPI:1215209838
Name:BALLEW THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:BALLEW THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:BALLEW
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR
Authorized Official - Phone:979-220-9406
Mailing Address - Street 1:3833 SOUTH TEXAS AVENUE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4039
Mailing Address - Country:US
Mailing Address - Phone:979-220-9406
Mailing Address - Fax:
Practice Address - Street 1:3833 SOUTH TEXAS AVENUE
Practice Address - Street 2:SUITE 111
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4039
Practice Address - Country:US
Practice Address - Phone:979-220-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564050000261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service