Provider Demographics
NPI:1841660727
Name:BALL, ALI (PTA)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 EASTERN AVE
Mailing Address - Street 2:APARTMENT C
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-9251
Mailing Address - Country:US
Mailing Address - Phone:606-922-4370
Mailing Address - Fax:
Practice Address - Street 1:850 NELLIE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1567
Practice Address - Country:US
Practice Address - Phone:937-981-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant