Provider Demographics
NPI:1780683375
Name:BALLINGER, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1568
Mailing Address - Country:US
Mailing Address - Phone:215-629-1270
Mailing Address - Fax:215-629-5531
Practice Address - Street 1:331 WILMINGTON PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-2277
Practice Address - Country:US
Practice Address - Phone:610-558-5866
Practice Address - Fax:610-558-6103
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA017193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist