Basic Information
| Provider Information | |||||||||
| NPI: | 1821665951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLIS | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 N HIGHLAND AVE NE UNIT 3521 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303075619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132650224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 NORTHEAST EXP, BLDG 8, STE. C | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705003848 | ||||||||
| FaxNumber: | 6784819261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2021 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT015323 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.