Marco William Balletto Jr.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT016159 Issued in GA

Practice address

855 Emory Point Dr Ste C-130
Atlanta, GA 30329-4022

Phone

(678) 553-9466

NPI assigned

Aug 24, 2022

Last updated

Aug 24, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kennestone Hospital, Inc

  dba Wellstar Kennestone Hospital Inpatient Psych Unit

  • Psychiatric Hospital Unit
  • Atlanta, GA
  • NPI 1689361438
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1104545094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 CIRCLE 75 PKWY SE STE 1400",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 EMORY POINT DR STE C-130",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303294022",
            "telephone_number": "678-553-9466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLETTO",
        "first_name": "MARCO",
        "middle_name": "WILLIAM",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT016159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard S Ballard, MD
• Wiley Perry Ballard III, M.D.
• William L Ballard, MD
• Samir Antonio Ballestas Naissir, MD
• Destiny Ballesteros-Lopez
• John R. Ballew, LPC
• Stephanie Ballis, DPT
• Dawn Collette Ballou-Anderson, PA-C
• Zyviera Shainece Ballou, MA, BCBA
• Ryan Michael Balmes, DPT

• Physical Therapist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.