Provider Demographics
NPI:1376568022
Name:BALL, JENNIFER R (RPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:BALL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2416 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1320
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:110 N WALMART DR
Practice Address - Street 2:SUITE F
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-5905
Practice Address - Country:US
Practice Address - Phone:662-779-1096
Practice Address - Fax:662-779-3949
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist