Provider Demographics
NPI:1508424870
Name:BALL, ALEX ANDERSON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:ANDERSON
Last Name:BALL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 HUNTERS CHASE DR APT 1C
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6125
Mailing Address - Country:US
Mailing Address - Phone:928-420-4151
Mailing Address - Fax:
Practice Address - Street 1:1512 HUNTERS CHASE DR APT 1C
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6125
Practice Address - Country:US
Practice Address - Phone:928-420-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11299703-2401225100000X
OHPT020156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty