Provider Demographics
NPI:1629566823
Name:BALLETTO, JOHN JOSEPH JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:BALLETTO
Suffix:JR
Gender:M
Credentials:LMT
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Mailing Address - Street 1:545 PAWTUCKET AVENUE
Mailing Address - Street 2:MAILBOX 304
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6094
Mailing Address - Country:US
Mailing Address - Phone:401-722-9991
Mailing Address - Fax:
Practice Address - Street 1:545 PAWTUCKET AVE STE A116
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6046
Practice Address - Country:US
Practice Address - Phone:401-722-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMT-00194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist