Provider Demographics
NPI:1629744875
Name:BALL, CARRIE LEIGH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LEIGH
Last Name:BALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 VICTORIA SQ
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4730
Practice Address - Country:US
Practice Address - Phone:601-926-2018
Practice Address - Fax:601-924-9746
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist