Provider Demographics
NPI:1477139640
Name:BALLEW, ADAM (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BALLEW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3451 TECHNOLOGICAL AVE
Mailing Address - Street 2:STE 15
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8353
Mailing Address - Country:US
Mailing Address - Phone:850-245-4260
Mailing Address - Fax:850-497-3284
Practice Address - Street 1:901 DOUGLAS AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2058
Practice Address - Country:US
Practice Address - Phone:407-865-7153
Practice Address - Fax:407-865-7159
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT368912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic