Provider Demographics
NPI:1619458783
Name:BALL, RICHARD ALBERT
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALBERT
Last Name:BALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 PASO FINO ST.
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-7640
Mailing Address - Country:US
Mailing Address - Phone:806-928-2084
Mailing Address - Fax:877-792-4777
Practice Address - Street 1:1400 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3718
Practice Address - Country:US
Practice Address - Phone:254-753-0291
Practice Address - Fax:877-792-4777
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2070612225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant