Provider Demographics
NPI:1497396436
Name:BALL SPORTS PERFORMANCE AND PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:BALL SPORTS PERFORMANCE AND PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:206-567-7740
Mailing Address - Street 1:13104 SW 220TH ST
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6334
Mailing Address - Country:US
Mailing Address - Phone:206-567-7740
Mailing Address - Fax:
Practice Address - Street 1:13104 SW 220TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6334
Practice Address - Country:US
Practice Address - Phone:206-567-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy