Bruce Spencer Ballard, PT
Individual provider Active NPI Physical Therapist · Ridgeland, MS
NPI 1700934346 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1700934346
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT2771 (MS)
- Practice address
- 711 Avignon Dr
Ridgeland, MS 39157-5120 - Phone
- (601) 605-6777
- Fax
- (601) 605-8869
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|
| PT2771 | MS | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2771 | MS | Yes |
Addresses
Primary practice location
711 Avignon Dr
Ridgeland, MS 39157-5120
Mailing address
1202 Harrison St
Tupelo, MS 38801-5646
Phone (662) 680-9416
Other providers in Ridgeland, MS
- Gagandeep Bal
- Balance Sleep Centers of Mississippi, Jackson, LLC
- Ann Parker Baldwin
- Mary Virginia Baldwin
- Janyce Ball
- Sheila Steen Ballard
- Lenora G. Balthis
- Pamela Ann Banes
- Douglas Santrell Banks
- Tricia Banks
All providers in Ridgeland, MS · Physical Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.