Provider Demographics
NPI:1134147218
Name:BALL, TODD RUSSELL (PT)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:RUSSELL
Last Name:BALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:899 LOGAN ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3130
Mailing Address - Country:US
Mailing Address - Phone:303-393-1600
Mailing Address - Fax:303-393-1777
Practice Address - Street 1:899 LOGAN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3130
Practice Address - Country:US
Practice Address - Phone:303-393-1600
Practice Address - Fax:303-393-1777
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO9224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4148Medicare PIN