Provider Demographics
NPI:1336311372
Name:BALLOW, TASSHENIA BERNICE (MPT)
Entity Type:Individual
Prefix:MS
First Name:TASSHENIA
Middle Name:BERNICE
Last Name:BALLOW
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-2005
Mailing Address - Country:US
Mailing Address - Phone:215-492-1079
Mailing Address - Fax:215-492-1083
Practice Address - Street 1:2718 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2005
Practice Address - Country:US
Practice Address - Phone:215-492-1079
Practice Address - Fax:215-492-1083
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist