Basic Information
| Provider Information | |||||||||
| NPI: | 1619458783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ALBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 PASO FINO ST. | ||||||||
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| City: | ROBINSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767067640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069282084 | ||||||||
| FaxNumber: | 8777924777 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767083718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547530291 | ||||||||
| FaxNumber: | 8777924777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2018 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2070612 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.