Susan Michelle Addison Ballman, MPT
Individual provider Active NPI Pediatric Physical Therapist · Potomac, MD
NPI 1447647136 · NPPES record last updated Apr 20, 2015
Key facts
- NPI
- 1447647136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Physical Therapist 2251P0200X
- License
- PT871358 (DC)
- Practice address
- 10901 Riverwood Dr
Potomac, MD 20854-1337 - Phone
- (301) 452-4633
- NPI assigned
- Apr 20, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19212 | MD | MD | Pharmacist |
| PT871358 | DC | MD | Pediatric Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 19212 | MD | |
| Pediatric Physical Therapist | 2251P0200X | PT871358 | DC | Yes |
Addresses
Primary practice location
10901 Riverwood Dr
Potomac, MD 20854-1337
Mailing address
10901 Riverwood Dr
Potomac, MD 20854-1337
Phone (301) 452-4633
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All providers in Potomac, MD · Pediatric Physical Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.