Active NPI
Daniel Ballou
- Physical Therapist
- Fredericksburg, VA
National Provider Identifier
1124478813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305210335
- Practice address
- 4932 Southpoint Pkwy
Fredericksburg, VA 22407-2659 - Phone
- (540) 891-1186
- NPI assigned
- Jun 14, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305210335 | VA | Primary |
Addresses
Primary practice location
4932 Southpoint Pkwy
Fredericksburg, VA 22407-2659
Mailing address
4932 Southpoint Pkwy
Fredericksburg, VA 22407-2659
Phone (540) 891-1186
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220810000584 | VA | Practitioner - Physical Therapist in Private Practice | 9537542444 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305210335 | VA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lucas Physical Therapy Inc | Physical Therapist | Current | Accepting new patients |
| Ballou Physiotherapy and Performance | Current | Accepting new patients | |
| Lucas Emg Specialists | Physical Therapist | Past | Accepting new patients |
Locations
7226B Williamson Rd
Roanoke, VA 24019
Phone (540) 366-9244
4325 Brambleton Ave
Ste A
Roanoke, VA 24018
535 Campbell Ave SW
Roanoke, VA 24016
Phone (917) 703-9977
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Roanoke, VA
- NPI 1285774745
-
- Physical Therapy Clinic/Center
- Glen Allen, VA
- NPI 1932694064
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465862400000",
"number": "1124478813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4932 SOUTHPOINT PKWY",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224072659",
"telephone_number": "540-891-1186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4932 SOUTHPOINT PKWY",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224072659",
"telephone_number": "540-891-1186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLOU",
"first_name": "DANIEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-14",
"last_updated": "2016-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305210335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.