Provider Demographics
NPI:1740894724
Name:BALL, LARRY ALLEN (LMBT)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ALLEN
Last Name:BALL
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S WALNUT CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2624
Mailing Address - Country:US
Mailing Address - Phone:336-285-6873
Mailing Address - Fax:
Practice Address - Street 1:123 S WALNUT CIR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2624
Practice Address - Country:US
Practice Address - Phone:336-285-6873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist