Provider Demographics
NPI:1295433126
Name:LEGEND PHYSICAL THERAPY OF BALLINGER, LLC
Entity type:Organization
Organization Name:LEGEND PHYSICAL THERAPY OF BALLINGER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:325-234-6733
Mailing Address - Street 1:15701 US HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:MILES
Mailing Address - State:TX
Mailing Address - Zip Code:76861-6700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 HUTCHINS AVE
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821
Practice Address - Country:US
Practice Address - Phone:325-234-6733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty