Provider Demographics
NPI:1659896421
Name:BALL, ALEX MYCHAL (ATC)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:MYCHAL
Last Name:BALL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 APPLEGATE PL
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-8703
Mailing Address - Country:US
Mailing Address - Phone:541-995-1280
Mailing Address - Fax:
Practice Address - Street 1:1074 APPLEGATE PL
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-8703
Practice Address - Country:US
Practice Address - Phone:541-995-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer