Provider Demographics
NPI:1821314949
Name:BALLONI, JOHN MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BALLONI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 E ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2604
Mailing Address - Country:US
Mailing Address - Phone:315-635-6025
Mailing Address - Fax:
Practice Address - Street 1:204 EAGLE VALLEY MALL
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1315
Practice Address - Country:US
Practice Address - Phone:315-857-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist