Provider Demographics
NPI:1023394715
Name:BALLARD, ASHTON (MT)
Entity type:Individual
Prefix:MS
First Name:ASHTON
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 SUNRISE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4583
Mailing Address - Country:US
Mailing Address - Phone:916-786-6055
Mailing Address - Fax:916-786-6452
Practice Address - Street 1:755 SUNRISE AVE STE 115
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4583
Practice Address - Country:US
Practice Address - Phone:916-786-6055
Practice Address - Fax:916-786-6452
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA041565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist