Provider Demographics
NPI:1386676724
Name:BALLENTINE, ANGEL (PT)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:
Last Name:BALLENTINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 KEYSTONE PARK DR UNIT 22
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6101
Mailing Address - Country:US
Mailing Address - Phone:919-410-7312
Mailing Address - Fax:
Practice Address - Street 1:4013 TRYON RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-4209
Practice Address - Country:US
Practice Address - Phone:919-410-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist