Provider Demographics
NPI:1285862755
Name:BALL, GERARD
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:ME
Mailing Address - Zip Code:04949-0181
Mailing Address - Country:US
Mailing Address - Phone:207-589-4544
Mailing Address - Fax:
Practice Address - Street 1:42 JACKSON RD
Practice Address - Street 2:
Practice Address - City:SEARSMONT
Practice Address - State:ME
Practice Address - Zip Code:04973
Practice Address - Country:US
Practice Address - Phone:207-589-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist