Provider Demographics
NPI:1649785841
Name:BALLARD, REGINALD E JR
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:E
Last Name:BALLARD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CHATHAM RD # R
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4188
Mailing Address - Country:US
Mailing Address - Phone:844-727-8883
Mailing Address - Fax:
Practice Address - Street 1:2305 185TH PL
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438
Practice Address - Country:US
Practice Address - Phone:708-368-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-10
Last Update Date:2023-10-18
Deactivation Date:2020-04-14
Deactivation Code:
Reactivation Date:2020-11-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P4000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPatient Transport