Provider Demographics
NPI:1750791620
Name:BALLETTI, DAVID ALEXANDER
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:BALLETTI
Suffix:
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 1:8901 SW 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2446
Mailing Address - Country:US
Mailing Address - Phone:305-484-4004
Mailing Address - Fax:
Practice Address - Street 1:107 ANTILLA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3301
Practice Address - Country:US
Practice Address - Phone:305-567-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist